Provider Demographics
NPI:1629728506
Name:ALVIDREZ, LETICIA (RDN)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:ALVIDREZ
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 1:4725 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-2220
Mailing Address - Country:US
Mailing Address - Phone:303-458-5302
Mailing Address - Fax:
Practice Address - Street 1:5075 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-2015
Practice Address - Country:US
Practice Address - Phone:303-458-5302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered