Provider Demographics
NPI:1467108985
Name:COUTURE, AMARGO (RD)
Entity Type:Individual
Prefix:
First Name:AMARGO
Middle Name:
Last Name:COUTURE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3158 VIA ALICANTE UNIT E
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2451
Mailing Address - Country:US
Mailing Address - Phone:201-256-5316
Mailing Address - Fax:
Practice Address - Street 1:3158 VIA ALICANTE UNIT E
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-2451
Practice Address - Country:US
Practice Address - Phone:201-256-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86242965133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered