Provider Demographics
NPI:1932604634
Name:BARROS, AMANDA NOEL (RD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NOEL
Last Name:BARROS
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 1:33523 VISTA COLINA
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1642
Mailing Address - Country:US
Mailing Address - Phone:909-801-4238
Mailing Address - Fax:
Practice Address - Street 1:33523 VISTA COLINA
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-1642
Practice Address - Country:US
Practice Address - Phone:909-801-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86070456133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered