Active NPI
Lisa Roberts, RD
- Registered Dietitian
- Riverside, CA
National Provider Identifier
1780861542
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 969335
- Practice address
- 11801 Pierce St
Riverside, CA 92505-4400 - Phone
- (951) 704-5993
- NPI assigned
- Jan 23, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 969335 | CA | Primary |
Addresses
Primary practice location
11801 Pierce St
Riverside, CA 92505-4400
Mailing address
29970 Technology Dr Ste 105
Murrieta, CA 92563-2646
Phone (951) 346-0064
Other names 1
- Ms. Lisa Roberts
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101028000274 | CA | Practitioner - Registered Dietitian Or Nutrition Professional | 0345434999 | Practice locations: Murrieta, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 969335 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Core Nutrition Group, Inc. | Dietitian, Registered | Current | Accepting new patients |
Locations
29970 Technology Dr
Ste 105D
Murrieta, CA 92563
Phone (951) 346-0064
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607472000000",
"number": "1780861542",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29970 TECHNOLOGY DR STE 105",
"city": "MURRIETA",
"state": "CA",
"postal_code": "925632646",
"telephone_number": "951-346-0064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11801 PIERCE ST",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925054400",
"telephone_number": "951-704-5993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "LISA",
"name_prefix": "Ms.",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-01-23",
"last_updated": "2020-12-09",
"certification_date": "2020-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "969335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LISA",
"last_name": "ROBERTS",
"prefix": "MS.",
"credential": "RD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.