Individual provider Active NPI

Magnolia Vela

  • Registered Dietitian
  • Long Beach, CA
National Provider Identifier
1083795231
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
MNT894684 Issued in CA
Practice address
6285 E Spring St # 284
Long Beach, CA 90808-4020
Phone
(562) 424-4055
Fax
(949) 577-4880
NPI assigned
Oct 17, 2006
Last updated
Jun 21, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Renal Nutrition Registered Dietitian 133VN1005X MNT894684 CA
Metabolic Nutrition Registered Dietitian 133VN1006X MNT894684 CA
Nutrition Education Nutritionist 133NN1002X MNT894684 CA
Registered Dietitian 133V00000X MNT894684 CA Primary

Addresses

Primary practice location

6285 E Spring St # 284
Long Beach, CA 90808-4020

Mailing address

6285 E Spring St # 284
Long Beach, CA 90808-4020
Phone (562) 424-4055

Other practice location 1

990 Highway 287 N
Mansfield, TX 76063-2607
Phone (562) 424-4055

Other identifiers 1

IdentifierTypeStateIssuer
MNT894684OtherCAREG DIETICIAN PROVIDER NO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060214000486 CA Practitioner - Registered Dietitian Or Nutrition Professional 6406861301 Reassigns benefits to 1 organization
I20221104000229 TX Practitioner - Registered Dietitian Or Nutrition Professional 6406861301 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MNT894684CAMDMetabolic Nutrition Registered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Nutrition As Therapy Inc. Dietitian, Registered CurrentSince Mar 8, 2007 Accepting new patients
Nutrition As Therapy Inc. Dietitian, Registered CurrentSince Mar 26, 2020 Accepting new patients
Nutrition As Therapy PastSince Apr 7, 2012 Accepting new patients
Omnicare Medical Group, Inc Past Accepting new patients

Locations

9750 Flower St
Bellflower, CA 90706
Phone (562) 281-9675

3711 Long Beach Blvd
Ste 904
Long Beach, CA 90807
Phone (562) 424-4055

6285 E Spring St
Long Beach, CA 90808
Phone (562) 204-6026

990 Highway 287 N
Mansfield, TX 76063
Phone (214) 334-2190

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1083795231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6285 E SPRING ST # 284",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908084020",
            "telephone_number": "562-424-4055",
            "fax_number": "949-577-4880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6285 E SPRING ST # 284",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908084020",
            "telephone_number": "562-424-4055",
            "fax_number": "949-577-4880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "990 Highway 287 N",
            "address_purpose": "LOCATION",
            "city": "Mansfield",
            "state": "TX",
            "postal_code": "760632607",
            "country_code": "US",
            "telephone_number": "562-424-4055",
            "fax_number": "949-577-4880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VELA",
        "first_name": "MAGNOLIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1005X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": "CA",
            "license": "MNT894684",
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "CA",
            "license": "MNT894684",
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "CA",
            "license": "MNT894684",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "MNT894684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REG DIETICIAN PROVIDER NO",
            "identifier": "MNT894684",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.