Provider Demographics
NPI:1184827669
Name:BRAGLIA-TARPEY, AMY M (MS, RD, CSR)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:BRAGLIA-TARPEY
Suffix:
Gender:F
Credentials:MS, RD, CSR
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BRAGLIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CSR
Mailing Address - Street 1:280 CAGNEY LN
Mailing Address - Street 2:#301
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2674
Mailing Address - Country:US
Mailing Address - Phone:949-278-4558
Mailing Address - Fax:949-271-5062
Practice Address - Street 1:280 CAGNEY LN
Practice Address - Street 2:#301
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2674
Practice Address - Country:US
Practice Address - Phone:949-278-4558
Practice Address - Fax:949-278-4558
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA898072133VN1005X, 133V00000X, 133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA898072OtherCOMMISSION ON DIETETIC REGISTRATION