Provider Demographics
NPI:1063853679
Name:MILLER, ALISSA A (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 ROBINHOOD ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2573
Mailing Address - Country:US
Mailing Address - Phone:713-800-6679
Mailing Address - Fax:
Practice Address - Street 1:2525 ROBINHOOD ST STE 1100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2573
Practice Address - Country:US
Practice Address - Phone:713-800-6679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81522133V00000X
TX1038969133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered