Provider Demographics
NPI:1164970513
Name:ZAWILSKI, ALEXANDRA JUSTINE (MS, RD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JUSTINE
Last Name:ZAWILSKI
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 LA PLAYA AVE
Mailing Address - Street 2:#15
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-6402
Mailing Address - Country:US
Mailing Address - Phone:916-207-8847
Mailing Address - Fax:
Practice Address - Street 1:1621 LA PLAYA AVE
Practice Address - Street 2:#15
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-6402
Practice Address - Country:US
Practice Address - Phone:916-207-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86010368133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered