Provider Demographics
NPI:1326598145
Name:MAGANA, ALYSSA JEAN (RDN, CD)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:JEAN
Last Name:MAGANA
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 AUBURN WAY N
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4100
Mailing Address - Country:US
Mailing Address - Phone:206-477-0600
Mailing Address - Fax:
Practice Address - Street 1:901 AUBURN WAY N
Practice Address - Street 2:SUITE A
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4100
Practice Address - Country:US
Practice Address - Phone:206-477-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA999791133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered