Basic Information
| Provider Information | |||||||||
| NPI: | 1346678604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOATWRIGHT | ||||||||
| FirstName: | GIUSEPPINA | ||||||||
| MiddleName: | CEFALO | ||||||||
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| Credential: | MS, RD, CHES, RYT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1313 LAUREL ST | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940705044 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 85 MIDDLESEX TPKE STE 3110 | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018035380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817441066 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2013 | ||||||||
| LastUpdateDate: | 11/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 4082 | MA | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133VN1201X | 4082 | MA | Y |
No ID Information.