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Individual

KELSEA JOHANNA CREGUT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RD

Contact information

Practice address
400 MOBIL AVE STE D27, CAMARILLO, CA 93010-6338
(805) 444-5919
(805) 830-1735
Mailing address
5709 CHERRY RIDGE DR, CAMARILLO, CA 93012-5515
(805) 444-5919

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1036705
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CB280422
MEDICARE
CA
Enumeration date
04/04/2016
Last updated
06/11/2019
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