Kelsea Johanna Palace, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1036705 Issued in CA

Practice address

400 Mobil Ave Ste D9
Camarillo, CA 93010-6376

Phone

(805) 444-5919

Fax

(805) 830-1735

NPI assigned

Apr 4, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kelsea Cregut Former name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

360 Nutrition Consulting LLCGroup PAC ID 8921347600, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• 360 Nutrition Consulting Inc

  • Registered Dietitian
  • Camarillo, CA
  • NPI 1033629175
  Medicare reassignment Care Compare group Authorized official

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

{
    "created_epoch": "1459728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785110400000",
    "number": "1376906594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5709 CHERRY RIDGE DR",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125515",
            "telephone_number": "805-444-5919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MOBIL AVE STE D9",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930106376",
            "telephone_number": "805-444-5919",
            "fax_number": "805-830-1735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALACE",
        "first_name": "KELSEA",
        "middle_name": "JOHANNA",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-04",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "1036705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CB280422",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEA",
            "last_name": "CREGUT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Pacifica Institute of Cosmetic & Reconstructive Surgery Medical Group
• Scott W Packham, DDS
• Joselyn Lizabeth Padilla
• Matthew Page
• Charisse Regina Palaad, MS
• Adrina Palacios
• Ayari Nataly Palencia Chavez
• Erin Palmer
• Terri Palmer
• Jaquelin Paniagua

• Registered Dietitian in Camarillo, CA
• Providers in Camarillo, CA by specialty
• Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.