MEDICARE: AUSTIN BOU RD, CDCES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1497394258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN BOU RD, CDCES

Provider Business Mailing Address
First Line	:	17901 PIONEER BLVD STE L113
Second Line	:
City	:	ARTESIA
State	:	CA
Zip	:	90701-3952
Country	:	US
Telephone Number	:	562-276-0126
Fax Number	:	855-610-2299

Provider Business Practice Location Address
First Line	:	4132 KATELLA AVE STE 100A
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3426
Country	:	US
Telephone Number	:	562-276-0126
Fax Number	:	855-610-2299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2019
Last Update Date	:	02/16/2026

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