Provider Demographics
NPI:1639437635
Name:KLOTZ, AMY GLYNN (RD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:GLYNN
Last Name:KLOTZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:GIBBS
Other - Last Name:GLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:606 ITHICA CT
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5168
Mailing Address - Country:US
Mailing Address - Phone:804-564-8760
Mailing Address - Fax:
Practice Address - Street 1:606 ITHICA CT
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5168
Practice Address - Country:US
Practice Address - Phone:804-564-8760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA816512133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
816512OtherCOMMISSION ON DIETETIC REGISTRATION