Active NPI
Renegade Nutrition LLC
- Registered Dietitian
- Union City, CA
National Provider Identifier
1013529411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Legal business name
- RENEGADE NUTRITION LLC
- Practice address
- 33947 Railroad Ave
Union City, CA 94587-3431 - Phone
- (408) 460-7319
- NPI assigned
- Aug 18, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jennifer Houser, RD
- Title
- Owner
- Phone
- (408) 460-7319
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
33947 Railroad Ave
Union City, CA 94587-3431
Mailing address
33947 Railroad Ave
Union City, CA 94587-3431
Phone (408) 460-7319
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205303260 | Medicaid | CA |
Other names 1
- Renegade Nutrition LLC
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | www.therenegadedietitian.com |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597708800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1597708800000",
"number": "1013529411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33947 RAILROAD AVE",
"city": "UNION CITY",
"state": "CA",
"postal_code": "945873431",
"telephone_number": "408-460-7319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33947 RAILROAD AVE",
"city": "UNION CITY",
"state": "CA",
"postal_code": "945873431",
"telephone_number": "408-460-7319"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RENEGADE NUTRITION LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-08-18",
"last_updated": "2020-08-18",
"certification_date": "2020-08-18",
"status": "A",
"authorized_official_last_name": "HOUSER",
"authorized_official_first_name": "JENNIFER",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "408-460-7319",
"authorized_official_credential": "RD"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1205303260",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "www.therenegadedietitian.com",
"affiliation": "N",
"address_1": "33947 Railroad Ave",
"city": "Union City",
"state": "CA",
"country_code": "US",
"postal_code": "945873431",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Renegade Nutrition LLC",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Union City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.