Active NPI
Amy Lyon, MS, RD
- Registered Dietitian
- Lakewood, CA
National Provider Identifier
1619667557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86021769
- Practice address
- 4529 Petaluma Ave
Lakewood, CA 90713-2829 - Phone
- (310) 962-5239
- NPI assigned
- May 12, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 | 86021769 | CA | Primary |
Addresses
Primary practice location
4529 Petaluma Ave
Lakewood, CA 90713-2829
Mailing address
4529 Petaluma Ave
Lakewood, CA 90713-2829
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86021769 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683849600000",
"number": "1619667557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4529 PETALUMA AVE",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907132829"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4529 PETALUMA AVE",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907132829",
"telephone_number": "310-962-5239"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYON",
"first_name": "AMY",
"credential": "MS, RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-12",
"last_updated": "2023-05-12",
"certification_date": "2023-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86021769",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.