Provider Demographics
NPI:1386041317
Name:EHSANI, ROXANA (RD)
Entity Type:Individual
Prefix:MS
First Name:ROXANA
Middle Name:
Last Name:EHSANI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SPRUCE PARK DR STE 313
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1468
Mailing Address - Country:US
Mailing Address - Phone:703-674-8068
Mailing Address - Fax:
Practice Address - Street 1:1350 SPRUCE PARK DR STE 313
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1468
Practice Address - Country:US
Practice Address - Phone:703-674-8068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1501X
VA1078707133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics