Individual provider Active NPI

Jerilyn Dee Gertzman, M.S., R.D., C.D.E.

  • Registered Dietitian
  • Westlake Village, CA
National Provider Identifier
1679859474
Registry record updated Jun 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Practice address
30700 Russell Ranch Rd Ste 250
Westlake Village, CA 91362
Phone
(818) 706-2567
Fax
(818) 706-3549
NPI assigned
Oct 25, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X Primary

Addresses

Primary practice location

30700 Russell Ranch Rd Ste 250
Westlake Village, CA 91362

Mailing address

6072 Lake Lindero Dr
Agoura Hills, CA 91301-4638
Phone (818) 706-8618

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
Credentials
Master of Science

NPI Registry JSON

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

{
    "created_epoch": "1319500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529625600000",
    "number": "1679859474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6072 LAKE LINDERO DR",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913014638",
            "telephone_number": "818-706-8618",
            "fax_number": "818-706-3549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30700 RUSSELL RANCH RD STE 250",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "91362",
            "telephone_number": "818-706-2567",
            "fax_number": "818-706-3549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERTZMAN",
        "first_name": "JERILYN",
        "middle_name": "DEE",
        "credential": "M.S., R.D., C.D.E.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-25",
        "last_updated": "2018-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westlake Village, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.