Provider Demographics
NPI:1821526351
Name:BRICENO, ALEXANDRA E (RD, LDN, CDN)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:E
Last Name:BRICENO
Suffix:
Gender:F
Credentials:RD, LDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 PRINCETON CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1501
Mailing Address - Country:US
Mailing Address - Phone:305-439-1589
Mailing Address - Fax:
Practice Address - Street 1:2504 PRINCETON CT
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-1501
Practice Address - Country:US
Practice Address - Phone:305-439-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7153133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered