Healthcare Provider Details

I. General information

NPI: 1730717042
Provider Name (Legal Business Name): JAMES CAIN PHD, RD, CSSD, CSOWM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FORT BLISS
EL PASO TX
79916
US

IV. Provider business mailing address

108 MAPLE AVE
NORTH AURORA IL
60542-1119
US

V. Phone/Fax

Practice location:
  • Phone: 703-436-9009
  • Fax:
Mailing address:
  • Phone: 815-545-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number86110767
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86110767
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: