Active NPI
Ann Marie Balthazor, R.D. C.D.
- Registered Dietitian
- San Diego, CA
National Provider Identifier
1679763478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 957102
- Practice address
- 1933 Hornblend St
Apt 21
San Diego, CA 92109-4582 - Phone
- (920) 539-0348
- NPI assigned
- Jul 27, 2007
- 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 | 957102 | CA | Primary |
| Registered Dietitian | 133V00000X | 10146262 | OR |
Addresses
Primary practice location
1933 Hornblend St
Apt 21
San Diego, CA 92109-4582
Mailing address
1933 Hornblend St
Apt 21
San Diego, CA 92109-4582
Phone (920) 539-0348
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 |
|---|---|---|---|
| 957102 | CA | MD | Registered Dietitian |
| 10146262 | OR | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1345075200000",
"number": "1679763478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1933 HORNBLEND ST",
"address_2": "APT 21",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921094582",
"telephone_number": "920-539-0348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1933 HORNBLEND ST",
"address_2": "APT 21",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921094582",
"telephone_number": "920-539-0348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALTHAZOR",
"first_name": "ANN",
"middle_name": "MARIE",
"credential": "R.D. C.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-07-27",
"last_updated": "2012-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "957102",
"primary": true
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OR",
"license": "10146262",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.