=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215819115
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CECELIA RENARD RD, LD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2025
-----------------------------------------------------
Last Update Date | 11/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BLDG 309 OUTER LOOP
-----------------------------------------------------
City | FORT IRWIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-282-4272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 742A CRAIG ROAD
-----------------------------------------------------
City | CARLISLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-551-6511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | DT90885
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------