Provider Demographics
NPI:1942716626
Name:MARLENA TANNER, RDN, LLC
Entity type:Organization
Organization Name:MARLENA TANNER, RDN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CEDS-C
Authorized Official - Phone:805-591-0712
Mailing Address - Street 1:2598 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1553
Mailing Address - Country:US
Mailing Address - Phone:805-591-0712
Mailing Address - Fax:833-264-5898
Practice Address - Street 1:2598 MAIN ST
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1553
Practice Address - Country:US
Practice Address - Phone:805-305-9911
Practice Address - Fax:833-264-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA929304133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty