Provider Demographics
NPI:1467505115
Name:LEVINE, ALYSE (RD, MS)
Entity Type:Individual
Prefix:
First Name:ALYSE
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:RD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 AVENUE OF THE STARS
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-6001
Mailing Address - Country:US
Mailing Address - Phone:310-526-7872
Mailing Address - Fax:310-564-0399
Practice Address - Street 1:1901 AVENUE OF THE STARS
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-6001
Practice Address - Country:US
Practice Address - Phone:310-526-7872
Practice Address - Fax:310-564-0399
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY926480133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered