Provider Demographics
NPI:1851776272
Name:ALIXANDRA FENTON
Entity Type:Organization
Organization Name:ALIXANDRA FENTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALIXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FENTON
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:949-294-7887
Mailing Address - Street 1:311 2ND ST
Mailing Address - Street 2:515
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4164
Mailing Address - Country:US
Mailing Address - Phone:949-294-7887
Mailing Address - Fax:
Practice Address - Street 1:100 LAFAYETTE CIR
Practice Address - Street 2:203
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-7688
Practice Address - Country:US
Practice Address - Phone:949-294-7887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty