Provider Demographics
NPI:1447790829
Name:PARKER-DEJESUS, ALEXANDRA (RDN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:PARKER-DEJESUS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5629 HARVEST RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6960 DESTINY DR
Practice Address - Street 2:STE. 100
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2993
Practice Address - Country:US
Practice Address - Phone:916-624-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86059359133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered