Active NPI
Nellie Elizabeth Campa Perez, RD, CDE
- Registered Dietitian
- San Bernardino, CA
National Provider Identifier
1033645528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86038877
- Practice address
- 724 Sequoia St
San Bernardino, CA 92407-2529 - Phone
- (909) 559-7555
- NPI assigned
- May 3, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86038877 | CA | Primary |
Addresses
Primary practice location
724 Sequoia St
San Bernardino, CA 92407-2529
Mailing address
11801 Pierce St
Ste 200
Riverside, CA 92505-4400
Phone (951) 317-7657
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86038877 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthcare Partners Affiliates Medical Group | Current | Accepting new patients | |
| Healthcare Partners Affiliates Medical Group | Current | Accepting new patients | |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Locations
1236 N Magnolia Ave
Anaheim, CA 92801
Phone (714) 995-1000
5957 W Ramsey St
Banning, CA 92220
Phone (951) 845-8864
824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706
1700 N Waterman Ave
Sn Bernrdno, CA 92404
Phone (909) 883-8611
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531699200000",
"number": "1033645528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11801 PIERCE ST",
"address_2": "STE 200",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925054400",
"telephone_number": "951-317-7657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "724 SEQUOIA ST",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924072529",
"telephone_number": "909-559-7555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPA PEREZ",
"first_name": "NELLIE",
"middle_name": "ELIZABETH",
"credential": "RD, CDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-03",
"last_updated": "2018-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86038877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.