Provider Demographics
NPI:1164094272
Name:HIGGASON, ALICIA RITCHEY
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:RITCHEY
Last Name:HIGGASON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:NICOLE
Other - Last Name:HIGGASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30189 LONGHORN DR
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-7645
Mailing Address - Country:US
Mailing Address - Phone:951-692-6805
Mailing Address - Fax:
Practice Address - Street 1:30189 LONGHORN DR
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-7645
Practice Address - Country:US
Practice Address - Phone:951-692-6805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered