Active NPI
Michael David Paulissen, R.D.
- Registered Dietitian
- Fresno, CA
National Provider Identifier
1346475357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 949877
- Practice address
- 2615 E Clinton Ave
Fresno, CA 93703-2223 - Phone
- (559) 225-6100
- Fax
- (559) 241-6483
- NPI assigned
- May 19, 2009
- Sex
- Male
- 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 | 949877 | CA | Primary |
Addresses
Primary practice location
2615 E Clinton Ave
Fresno, CA 93703-2223
Mailing address
2615 E Clinton Ave
Fresno, CA 93703-2223
Phone (559) 225-6100
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 |
|---|---|---|---|
| 949877 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242691200000",
"number": "1346475357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2615 E CLINTON AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937032223",
"telephone_number": "559-225-6100",
"fax_number": "559-241-6483"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2615 E CLINTON AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937032223",
"telephone_number": "559-225-6100",
"fax_number": "559-241-6483"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAULISSEN",
"first_name": "MICHAEL",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "R.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-19",
"last_updated": "2009-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "949877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.