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General NPI Number Information
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NPI Number | 1528848355
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Entity Type | Individual
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Provider Name | NICHOLAS JOHN BOGDIS RDN
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Gender | Male
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 10633 CRYSTAL AIRE RD.
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City | PINON HILLS
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State | CA
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Zip | 92372
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Country | US
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Telephone | 909-698-0038
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 721497
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City | PINON HILLS
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State | CA
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Zip | 92372-1497
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Country | US
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Telephone | 909-698-0038
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Fax |
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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 | 86211240
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License Number State | CA
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