Active NPI
Kelsy Bonnet
- Registered Dietitian
- Grand Terrace, CA
National Provider Identifier
1477220796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 11980 Canary CT
Grand Terrace, CA 92313-5317 - Phone
- (949) 630-6099
- NPI assigned
- Aug 25, 2021
- Last updated
- May 10, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86106455 | ||
| Registered Dietitian | 133V00000X | CA | Primary |
Addresses
Primary practice location
11980 Canary CT
Grand Terrace, CA 92313-5317
Mailing address
24042 Silverbay Dr
Lake Forest, CA 92630-5148
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| --- | Other | NO OTHER IDENTIFIER |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683676800000",
"number": "1477220796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24042 SILVERBAY DR",
"city": "LAKE FOREST",
"state": "CA",
"postal_code": "926305148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11980 CANARY CT",
"city": "GRAND TERRACE",
"state": "CA",
"postal_code": "923135317",
"telephone_number": "949-630-6099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONNET",
"first_name": "KELSY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-25",
"last_updated": "2023-05-10",
"certification_date": "2021-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": "86106455",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NO OTHER IDENTIFIER",
"identifier": "---",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Terrace, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.