Provider Demographics
NPI:1467671925
Name:ALEJANDRO, VICTORIA B (RD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:B
Last Name:ALEJANDRO
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 1:36179 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1555
Mailing Address - Country:US
Mailing Address - Phone:510-825-2287
Mailing Address - Fax:408-451-6012
Practice Address - Street 1:36179 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-1555
Practice Address - Country:US
Practice Address - Phone:510-825-2287
Practice Address - Fax:408-451-6012
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910591133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered