Provider Demographics
NPI:1245905090
Name:MARZULLO, ALEXANDRA (RD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MARZULLO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SE 177TH AVE UNIT A8
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1847
Mailing Address - Country:US
Mailing Address - Phone:845-242-2347
Mailing Address - Fax:
Practice Address - Street 1:3101 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3095
Practice Address - Country:US
Practice Address - Phone:971-282-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty