Healthcare Provider Details

I. General information

NPI: 1417328121
Provider Name (Legal Business Name): VANESSA JOANA ROJAS-BAUTISTA R.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 S CALHOUN PL
STAR ID
83669-5310
US

IV. Provider business mailing address

680 S CALHOUN PL
STAR ID
83669-5310
US

V. Phone/Fax

Practice location:
  • Phone: 208-353-1528
  • Fax:
Mailing address:
  • Phone: 208-599-0341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number1096678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: