Provider Demographics
NPI:1699221127
Name:YESIAN, ALEXANDRA REISSMANN (RDN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:REISSMANN
Last Name:YESIAN
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 1:3394 SOUTH CT
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3530
Mailing Address - Country:US
Mailing Address - Phone:650-269-2216
Mailing Address - Fax:
Practice Address - Street 1:3394 SOUTH CT
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3530
Practice Address - Country:US
Practice Address - Phone:650-269-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86058452133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered