Provider Demographics
NPI:1639936958
Name:CISNEROS, ALEXANDRA (RD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:CISNEROS
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 1:1410 HYDE PARK BLVD APT 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-2580
Mailing Address - Country:US
Mailing Address - Phone:832-231-4142
Mailing Address - Fax:
Practice Address - Street 1:1410 HYDE PARK BLVD APT 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-2580
Practice Address - Country:US
Practice Address - Phone:832-231-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88429133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered