Provider Demographics
NPI:1902278526
Name:HATHAWAY, AMY (RDN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HATHAWAY
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 1:26456 AMBIA
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-3331
Mailing Address - Country:US
Mailing Address - Phone:949-599-6781
Mailing Address - Fax:
Practice Address - Street 1:26456 AMBIA
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3331
Practice Address - Country:US
Practice Address - Phone:949-599-6781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA851825133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered