Provider Demographics
NPI:1215655394
Name:GEISSEL, ELISA (RDN)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:GEISSEL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-5019
Mailing Address - Country:US
Mailing Address - Phone:661-428-1446
Mailing Address - Fax:
Practice Address - Street 1:798 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-5019
Practice Address - Country:US
Practice Address - Phone:661-428-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA958612133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered