Active NPI
Stacy Wagner
- Registered Dietitian
- Mission Viejo, CA
National Provider Identifier
1679444756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 926900
- Practice address
- 27216 Regio
Mission Viejo, CA 92692-3287 - Phone
- (513) 377-7938
- NPI assigned
- Sep 13, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontological Nutrition Registered Dietitian | 133VN1101X | 936900 | CA | |
| Registered Dietitian | 133V00000X | 926900 | CA | Primary |
Addresses
Primary practice location
27216 Regio
Mission Viejo, CA 92692-3287
Mailing address
27216 Regio
Mission Viejo, CA 92692-3287
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 926900 | CA | MD | Registered Dietitian |
| 936900 | CA | MD | Gerontological Nutrition Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1757721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757721600000",
"number": "1679444756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27216 REGIO",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "926923287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27216 REGIO",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "926923287",
"telephone_number": "513-377-7938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "STACY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-09-13",
"last_updated": "2025-09-13",
"certification_date": "2025-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1101X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Gerontological",
"state": "CA",
"license": "936900",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "926900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mission Viejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.