Provider Demographics
NPI:1821636283
Name:ROXANA EHSANI
Entity Type:Organization
Organization Name:ROXANA EHSANI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RD
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:EHSANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-674-8068
Mailing Address - Street 1:1350 SPRUCE PARK DR STE 313
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1468
Mailing Address - Country:US
Mailing Address - Phone:703-674-8068
Mailing Address - Fax:
Practice Address - Street 1:1350 SPRUCE PARK DR STE 313
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1468
Practice Address - Country:US
Practice Address - Phone:703-674-8068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty