Active NPI
Elizabeth Bolduc, RD
- Registered Dietitian
- Newport Beach, CA
National Provider Identifier
1275199903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86046375
- Practice address
- 2138 Loggia
Newport Beach, CA 92660-9038 - Phone
- (949) 338-4154
- NPI assigned
- May 17, 2019
- 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 | 86046375 | CA | Primary |
Addresses
Primary practice location
2138 Loggia
Newport Beach, CA 92660-9038
Mailing address
PO Box 80912
San Marino, CA 91118-8912
Other names 1
- Elizabeth Cazares
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86046375 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marjorie Nolan Cohn LLC | Dietitian, Registered | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641859200000",
"number": "1275199903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 80912",
"city": "SAN MARINO",
"state": "CA",
"postal_code": "911188912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2138 LOGGIA",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926609038",
"telephone_number": "949-338-4154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLDUC",
"first_name": "ELIZABETH",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-17",
"last_updated": "2022-01-11",
"certification_date": "2022-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86046375",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ELIZABETH",
"last_name": "CAZARES",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Newport Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.