Jeniffer Beadles, REGISTERED DIETITIAN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86070004 Issued in CA

Practice address

4653 Carmel Mountain Rd Ste 308-1018
San Diego, CA 92130-6650

Phone

(619) 943-1214

NPI assigned

Jul 8, 2022

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Deep Dive Nutrition

  • Registered Dietitian
  • San Diego, CA
  • NPI 1841923554

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1657238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657238400000",
    "number": "1487387197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4653 CARMEL MOUNTAIN RD STE 308-1018",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921306650",
            "telephone_number": "619-943-1214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4653 CARMEL MOUNTAIN RD STE 308-1018",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921306650",
            "telephone_number": "619-943-1214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEADLES",
        "first_name": "JENIFFER",
        "credential": "REGISTERED DIETITIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-08",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "86070004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Beachy
• Janet Meong Beack, O.D.
• Luann Sue Beacom, N.P.
• Beacon Family Therapy, Prof. Corp.
• Dylan Steven Beadle
• Laura Dora Beadles, ACSW
• Jason Douglas Beadore-Minoff, SFIDC
• Benjamin Ryan Beal, M.D
• Brandon Beal
• Catalina Beal

• Registered Dietitian in San Diego, CA
• Providers in San Diego, CA by specialty
• Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.