Holly Gauthun, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86343557 Issued in CA

Practice address

1695 S San Jacinto Ave Ste a
San Jacinto, CA 92583-5103

Phone

(951) 330-3100

NPI assigned

Aug 13, 2024

Last updated

Aug 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Stallant Medical Group Inc

  • Rural Health Clinic/Center
  • Crescent City, CA
  • NPI 1366082463
  Medicare reassignment
• Moeller-Bertram Medical Corporation

  dba Lifekind Health

  • Pain Medicine Physician
  • Rancho Mirage, CA
  • NPI 1699586388
  NPD
• Stallant Medical Group Inc

  dba Stallant Health & Wellness

  • Rural Health Clinic/Center
  • Highland, CA
  • NPI 1508683111
  NPD
• Tobias Moeller-Bertram MD Corporation

  dba Lifekind Health

  • Durable Medical Equipment & Medical Supplies
  • Indio, CA
  • NPI 1861389199
  NPD
• Tobias Moeller-Bertram MD Corporation

  dba Lifekind Health

  • Pain Medicine (Anesthesiology) Physician
  • Rancho Mirage, CA
  • NPI 1922440684
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1346071917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1695 S SAN JACINTO AVE STE A",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835103",
            "telephone_number": "360-775-5337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 S SAN JACINTO AVE STE A",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835103",
            "telephone_number": "951-330-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUTHUN",
        "first_name": "HOLLY",
        "credential": "RDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-13",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "86343557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fidel Garcia Calderon, DDS
• Alexandria Briana Garcia
• Lisa Garcia, FNP
• Garfield Beach CVS, L.L.C (CVS Pharmacy #08943)
• Lucy N Gathuu
• Gene Kim (San Jacinto Pharmacy)
• Gentle Soul Guest Home LLC
• George Kyriopoulos
• GHC of PHF Gardens LLC (Bradley Gardens Focused Treatment Center)
• GHC of San Jacinto LLC

• Registered Dietitian in San Jacinto, CA
• Providers in San Jacinto, CA by specialty
• Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; 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.

Verify at the official NPI Registry.