Provider Demographics
NPI:1477975456
Name:VERGARA ALESHIRE, CHRISTINA MARIA (RDN, LD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIA
Last Name:VERGARA ALESHIRE
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36310
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-6310
Mailing Address - Country:US
Mailing Address - Phone:702-382-1599
Mailing Address - Fax:702-240-4962
Practice Address - Street 1:2481 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0825
Practice Address - Country:US
Practice Address - Phone:702-382-1599
Practice Address - Fax:702-240-4962
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32293DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered