Amanda Blake, MS, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

RD86027382 Issued in CA

Practice address

1672 Sycamore Dr Apt 302
Simi Valley, CA 93065-3733

Phone

(805) 404-0155

Fax

(855) 882-5211

NPI assigned

Feb 23, 2017

Sex

Female

Sole proprietor

No

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 CA

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Pacific Nutrition Partners, LLC

  • Registered Dietitian
  • Studio City, CA
  • NPI 1598264293

  Dietitian, Registered

  NPD (past) Authorized official

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

{
    "created_epoch": "1487808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725062400000",
    "number": "1225577208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1672 SYCAMORE DR APT 302",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930653733",
            "telephone_number": "805-404-0155",
            "fax_number": "855-882-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1672 SYCAMORE DR APT 302",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930653733",
            "telephone_number": "805-404-0155",
            "fax_number": "855-882-5211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4160 Klump Ave",
            "address_purpose": "LOCATION",
            "city": "Studio City",
            "state": "CA",
            "postal_code": "916023314",
            "country_code": "US",
            "telephone_number": "310-801-3418",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "AMANDA",
        "credential": "MS, RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-23",
        "last_updated": "2024-08-31",
        "certification_date": "2024-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "RD86027382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Urvi Prakashbhai Bhatt
• Christian Bieniek
• Lexi Kay Bieniek
• Bikram J Soni MD Medical Corporation
• Biomotion Physical Therapy
• Kelly Bleckley, M.A., CCC-SLP
• Stephanie Marie Blough, PT
• BLS CPR & First Aid Outreach
• Blueray Home Health, Inc.
• Body Mechanix Physical Therapy Inc

• Registered Dietitian in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.