Amber James Wagstaff, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

23320 Canyon Lake Dr N
Canyon Lake, CA 92587-8007

Phone

(714) 809-2993

NPI assigned

Oct 15, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19691/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Season Clinical Care P.a.

  • Registered Dietitian
  • Irving, TX
  • NPI 1649933565

  AZ, Dietitian, Registered

  Medicare reassignment NPD
• Uhling Consulting, LLC

  • Registered Dietitian
  • Phoenix, AZ
  • NPI 1609171636

  Dietitian, Registered

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1093313603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23320 CANYON LAKE DR N",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "925878007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23320 CANYON LAKE DR N",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "925878007",
            "telephone_number": "714-809-2993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGSTAFF",
        "first_name": "AMBER",
        "middle_name": "JAMES",
        "credential": "RDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-15",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marygrace Thompson, LVN
• Kali Tiefenthaler
• Michael Tiideberg
• TLC Enterprise, Inc.
• Hedley Vankuch, AMFT
• Steven E. Weidler, D.D.S.
• Julie Zimmerer, DC

• Registered Dietitian in Canyon Lake, CA
• Providers in Canyon Lake, CA by specialty
• Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; 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.