Provider Demographics
NPI:1043798655
Name:AUGUST, BUCK (MS, RDN)
Entity Type:Individual
Prefix:
First Name:BUCK
Middle Name:
Last Name:AUGUST
Suffix:
Gender:M
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5734 CANYON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5503
Mailing Address - Country:US
Mailing Address - Phone:530-876-7179
Mailing Address - Fax:530-876-7169
Practice Address - Street 1:5734 CANYON VIEW DR
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5503
Practice Address - Country:US
Practice Address - Phone:530-876-7179
Practice Address - Fax:530-876-7169
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA952097133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered