Provider Demographics
NPI:1831601095
Name:REGAN, AMANDA (RD)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:REGAN
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 1:24341 PASTO RD APT A
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2219
Mailing Address - Country:US
Mailing Address - Phone:949-874-3080
Mailing Address - Fax:
Practice Address - Street 1:24341 PASTO RD APT A
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2219
Practice Address - Country:US
Practice Address - Phone:949-874-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86013366133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric