Active NPI
Cerissa Roman, MPH, RDN
- Registered Dietitian
- Lake Forest, CA
National Provider Identifier
1275120883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 951354
- Practice address
- 1074 Viejo Hills Dr
Lake Forest, CA 92610-3029 - Phone
- (863) 558-5218
- NPI assigned
- Dec 29, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Renal Nutrition Registered Dietitian | 133VN1005X | 951354 | CA | |
| Registered Dietitian | 133V00000X | 951354 | CA | Primary |
Addresses
Primary practice location
1074 Viejo Hills Dr
Lake Forest, CA 92610-3029
Mailing address
1074 Viejo Hills Dr
Lake Forest, CA 92610-3029
Phone (863) 558-5218
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 |
|---|---|---|---|
| 951354 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609200000000",
"number": "1275120883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1074 VIEJO HILLS DR",
"city": "LAKE FOREST",
"state": "CA",
"postal_code": "926103029",
"telephone_number": "863-558-5218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1074 VIEJO HILLS DR",
"city": "LAKE FOREST",
"state": "CA",
"postal_code": "926103029",
"telephone_number": "863-558-5218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROMAN",
"first_name": "CERISSA",
"name_prefix": "Mrs.",
"credential": "MPH, RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-29",
"last_updated": "2020-12-29",
"certification_date": "2020-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1005X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Renal",
"state": "CA",
"license": "951354",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "951354",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Forest, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 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.