Active NPI
Kelly Blasco, RDN
- Registered Dietitian
- Los Angeles, CA
National Provider Identifier
1750906343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86094015
- Practice address
- 633 W 5TH St
Los Angeles, CA 90071-2005 - Phone
- (323) 391-7262
- NPI assigned
- Jun 10, 2020
- Sex
- Female
- Sole proprietor
- No
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 | 86094015 | CA | Primary |
Addresses
Primary practice location
633 W 5TH St
Los Angeles, CA 90071-2005
Mailing address
1048 Irvine Ave # 768
Newport Beach, CA 92660-4602
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86094015 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591747200000",
"number": "1750906343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1048 IRVINE AVE # 768",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926604602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 W 5TH ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900712005",
"telephone_number": "323-391-7262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLASCO",
"first_name": "KELLY",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-10",
"last_updated": "2020-06-10",
"certification_date": "2020-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86094015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.