Provider Demographics
NPI:1801814140
Name:EDIONWE, ALEXANDER O (RD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:O
Last Name:EDIONWE
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 W ALBERTA RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9402
Mailing Address - Country:US
Mailing Address - Phone:956-618-1242
Mailing Address - Fax:956-618-1360
Practice Address - Street 1:3133 W ALBERTA RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9402
Practice Address - Country:US
Practice Address - Phone:956-618-1242
Practice Address - Fax:956-618-1360
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04788133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered