Provider Demographics
NPI:1982227179
Name:ANZAI, ALYSSA (RD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:ANZAI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:NAGOSHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:3127 HUELANI DR APT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1290
Mailing Address - Country:US
Mailing Address - Phone:808-203-0495
Mailing Address - Fax:
Practice Address - Street 1:459 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1522
Practice Address - Country:US
Practice Address - Phone:808-433-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI199-LD133V00000X
HI86102952133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered