Provider Demographics
NPI:1225553936
Name:CALLAHAN, ALYSSA (MS RDN)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MS RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 MARIN ST STE 228
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4231
Mailing Address - Country:US
Mailing Address - Phone:805-267-9338
Mailing Address - Fax:805-930-0101
Practice Address - Street 1:509 MARIN ST STE 228
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4231
Practice Address - Country:US
Practice Address - Phone:805-267-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86064070133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86064070OtherCOMMISSION ON DIETETIC REGISTRATION