Active NPI
Jillian Elise Nybakken, RDN
- Registered Dietitian
- Riverside, CA
National Provider Identifier
1265053425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86094662
- Practice address
- 11801 Pierce St Ste 200
Riverside, CA 92505-4400 - Phone
- (951) 750-0085
- NPI assigned
- Apr 29, 2020
- Last updated
- Sep 12, 2024
- 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 | 86094662 | CA | Primary |
Addresses
Primary practice location
11801 Pierce St Ste 200
Riverside, CA 92505-4400
Mailing address
11021 Meyers Dr
Rancho Cucamonga, CA 91730-6892
Phone (818) 464-8223
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jillian@lifequalityrd.net | Direct | LIFEQUALITY Nutrition Network Cooperative Inc. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86094662 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726099200000",
"number": "1265053425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11021 MEYERS DR",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917306892",
"telephone_number": "818-464-8223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11801 PIERCE ST STE 200",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925054400",
"telephone_number": "951-750-0085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NYBAKKEN",
"first_name": "JILLIAN",
"middle_name": "ELISE",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-29",
"last_updated": "2024-09-12",
"certification_date": "2024-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86094662",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jillian@lifequalityrd.net",
"affiliation": "Y",
"endpointDescription": "Work Email",
"affiliationName": "LIFEQUALITY Nutrition Network Cooperative Inc.",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Email",
"address_1": "11801 Pierce St Ste 200",
"city": "Riverside",
"state": "CA",
"country_code": "US",
"postal_code": "925054400",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.