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General NPI Number Information
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NPI Number | 1497394258
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Entity Type | Individual
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Provider Name | AUSTIN BOU RD, CDCES
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Gender | Male
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Dates
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Enumeration Date | 12/27/2019
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 4132 KATELLA AVE STE 100A
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3426
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Country | US
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Telephone | 562-276-0126
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Fax | 855-610-2299
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Provider Business Mailing Address
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Address Line | 17901 PIONEER BLVD STE L113
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City | ARTESIA
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State | CA
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Zip | 90701-3952
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Country | US
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Telephone | 562-276-0126
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Fax | 855-610-2299
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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