Active NPI
Tracy Rachae Granberry, RD
- Registered Dietitian
- Riverside, CA
National Provider Identifier
1376028340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 920321
- Practice address
- 11801 Pierce St
Riverside, CA 92505-4408 - Phone
- (951) 750-0085
- NPI assigned
- Sep 26, 2018
- 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 | 920321 | CA | Primary |
Addresses
Primary practice location
11801 Pierce St
Riverside, CA 92505-4408
Mailing address
2084 La Luna Way
Pomona, CA 91767-2732
Phone (909) 576-3496
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190822002606 | CA | Practitioner - Registered Dietitian Or Nutrition Professional | 4587992953 | Practice locations: Riverside, CA; Ontario, CA; Diamond Bar, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 920321 | CA | MD | Registered Dietitian |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537920000000",
"number": "1376028340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2084 LA LUNA WAY",
"city": "POMONA",
"state": "CA",
"postal_code": "917672732",
"telephone_number": "909-576-3496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11801 PIERCE ST",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925054408",
"telephone_number": "951-750-0085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANBERRY",
"first_name": "TRACY",
"middle_name": "RACHAE",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-26",
"last_updated": "2018-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "920321",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 26, 2018; 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.