Healthcare Provider Details

I. General information

NPI: 1679995567
Provider Name (Legal Business Name): JESSICA FREESE MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5235 MISSION OAKS BLVD # 875
CAMARILLO CA
93012-5400
US

IV. Provider business mailing address

5235 MISSION OAKS BLVD # 875
CAMARILLO CA
93012-5400
US

V. Phone/Fax

Practice location:
  • Phone: 909-419-5687
  • Fax:
Mailing address:
  • Phone: 909-419-5687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1084037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: