Provider Demographics
NPI:1609588748
Name:MAESTAS, AMANDA CLAIRE (RDN)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CLAIRE
Last Name:MAESTAS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ARIA AVE S
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8088
Mailing Address - Country:US
Mailing Address - Phone:559-800-3195
Mailing Address - Fax:
Practice Address - Street 1:2350 W SHAW AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3412
Practice Address - Country:US
Practice Address - Phone:559-451-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86070054133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered