Provider Demographics
NPI:1497394258
Name:BOU, AUSTIN (RD, CDCES)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:BOU
Suffix:
Gender:
Credentials:RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17901 PIONEER BLVD STE L113
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-3952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 N SANTA ANITA AVE STE 800
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3129
Practice Address - Country:US
Practice Address - Phone:562-276-0126
Practice Address - Fax:855-610-2299
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered