Healthcare Provider Details

I. General information

NPI: 1710584701
Provider Name (Legal Business Name): ELIZABETH ANN BARTH MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRERA 2B OESTE NO 15-15 TORRES DEL BOSQUE APTO S03-A
CALI VALLE DEL CAUCA
760045
CO

IV. Provider business mailing address

867 BOYLSTON ST STE 500
BOSTON MA
02116-2774
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 857-452-1364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4628
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: