Active NPI
Jacqueline Carbajal
- Registered Dietitian
- Glendale, AZ
National Provider Identifier
1003726381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86374859
- Practice address
- 18001 N 79TH Ave Ste A12
Glendale, AZ 85308-8398 - Phone
- (623) 399-6825
- Fax
- (623) 505-3474
- NPI assigned
- Sep 9, 2026
- Last updated
- Sep 9, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86374859 | AZ | Primary |
Addresses
Primary practice location
18001 N 79TH Ave Ste A12
Glendale, AZ 85308-8398
Mailing address
18001 N 79TH Ave Ste A12
Glendale, AZ 85308-8398
Phone (623) 399-6825
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86374859 | AZ | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Am Nutrition Services | Dietitian, Registered | Current | Accepting new patients |
Locations
18001 N 79th Ave
Ste A12
Glendale, AZ 85308
Phone (623) 321-5380
10000 N 31st Ave
Ste C105
Phoenix, AZ 85051
Phone (602) 674-1068
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788912000000",
"number": "1003726381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18001 N 79TH AVE STE A12",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853088398",
"telephone_number": "623-399-6825",
"fax_number": "623-505-3474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18001 N 79TH AVE STE A12",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853088398",
"telephone_number": "623-399-6825",
"fax_number": "623-505-3474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARBAJAL",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-09-09",
"last_updated": "2026-09-09",
"certification_date": "2026-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AZ",
"license": "86374859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.