Provider Demographics
NPI:1093951618
Name:GERTZ, AMY (RD, CNSD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GERTZ
Suffix:
Gender:F
Credentials:RD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S SIERRA MADRE BLVD
Mailing Address - Street 2:#307
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4101
Mailing Address - Country:US
Mailing Address - Phone:323-361-3779
Mailing Address - Fax:
Practice Address - Street 1:125 S SIERRA MADRE BLVD
Practice Address - Street 2:#307
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4101
Practice Address - Country:US
Practice Address - Phone:323-361-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CMS200106OtherCMS NUMBER (CHILDRENS MEDICAL SERVICES)