Elise Boretz specialises in Nutrition, Gerontological. currently works in California.
| NPI Number | 1457977530 |
| Provider Name | Elise Boretz |
| Credential | |
| Specialization | Nutrition, Gerontological |
| Medical School Name | |
| Graduation Year | |
| Gender | |
| Entity Type | Individual |
| PAC ID by PECOS | |
| Professional Enrollment ID | |
| Enumeration Date | 06/24/2020 |
| Last Update Date | 06/24/2020 |
| Business Practice address |
3820 MARTIN LUTHER KING JR BLVD, Lynwood, 90262-3625 California View on Google Map |
| Business Practice phone | 310-632-0415 |
| Business Practice fax | |
| Mailing address |
3820 MARTIN LUTHER KING JR BLVD, Lynwood, 90262-3625 California View on Google Map |
| Other phone | 310-632-0415 |
| Other fax | |
| Email Address | shannonfig@domain.com Reval Email Address |
Practices in Lynwood
Lynwood, California
| Field Name | Field Value |
|---|---|
| NPI | 1457977530 |
| 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. | |
| Entity Type | Individual |
Code describing the type of health care provider that is being assigned an NPI. Codes are:
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| Is Sole Proprietor | N |
Indicate whether provider is a sole proprietor.
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| Provider Last Name (Legal Name) | Boretz |
| The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. | |
| Provider First Name | Elise |
| The first name of the provider, if the provider is an individual. | |
| Provider Credential Text | RD |
| The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS. | |
| Provider First Line Business Mailing Address | 3820 MARTIN LUTHER KING JR BLVD |
| The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''. | |
| Provider Business Mailing Address City Name | Lynwood |
| The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''. | |
| Provider Business Mailing Address State Name | California |
| The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''. | |
| Provider Business Mailing Address Postal Code | 90262-3625 |
| The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''. | |
| Provider Business Mailing Address Country Code | US |
| The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''. | |
| Provider Business Mailing Address Telephone Number | 310-632-0415 |
| The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''. | |
| Provider First Line Business Practice Location Address | 3820 MARTIN LUTHER KING JR BLVD |
| The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. | |
| Provider Business Practice Location Address City Name | Lynwood |
| The city name in the location address of the provider being identified. | |
| Provider Business Practice Location Address State Name | California |
| The State or Province name in the location address of the provider being identified. | |
| Provider Business Practice Location Address Postal Code | 90262-3625 |
| The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. | |
| Provider Business Practice Location Address Country Code | US |
| The country code in the location address of the provider being identified. | |
| Provider Business Practice Location Address Telephone Number | 310-632-0415 |
| The telephone number associated with the location address of the provider being identified. | |
| Provider Enumeration Date | 06/24/2020 |
| The date the provider was assigned a unique identifier (assigned an NPI). | |
| Last Update Date | 06/24/2020 |
| The date that a record was last updated or changed. | |
| Healthcare Provider Taxonomy Code #1 | 133VN1101X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 1 | An individual who is a Specialist in Gerontological Nutrition and provides nutrition care to promote quality of life and optimal health for older adults across the continuum of care, including: acute care, post-acute care, primary care, long-term care, assisted living, home care, palliative care, community-based nutrition, food service, correctional facilities, and government programs. RDN who works indirectly with gerontological nutrition through roles in management, industry, education, and research. |
| Healthcare Provider Taxonomy #1 | |
| Healthcare Provider Primary Taxonomy Switch 1 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #2 | 133V00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 2 | A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation. |
| Healthcare Provider Taxonomy #2 | |
| Healthcare Provider Primary Taxonomy Switch 2 | Y |
Primary Taxonomy:
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