Provider Demographics
NPI:1598385346
Name:LESSA, ALEXANDRA NICOLE (RD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:LESSA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ALLY
Other - Middle Name:NICOLE
Other - Last Name:LESSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:591 HILLTOP DR APT 22
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-4836
Mailing Address - Country:US
Mailing Address - Phone:530-520-5118
Mailing Address - Fax:
Practice Address - Street 1:591 HILLTOP DR APT 22
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4836
Practice Address - Country:US
Practice Address - Phone:530-520-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86150516133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered