=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649197666
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARA STANTZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2026
-----------------------------------------------------
Last Update Date | 07/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 CITRACADO PKWY
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92025-6428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-743-1431
-----------------------------------------------------
Fax | 760-743-6455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4375 TUOLUMNE PL
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92010-7924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-539-5699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number | 20420467
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 874978
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------