Provider Demographics
NPI:1750004644
Name:AGUAYO RODRIGUEZ, ALEJANDRA JOSELIE (BACHELORS)
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:JOSELIE
Last Name:AGUAYO RODRIGUEZ
Suffix:
Gender:F
Credentials:BACHELORS
Other - Prefix:
Other - First Name:ALEJANDRA
Other - Middle Name:JOSELINE
Other - Last Name:AGUAYO RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLD
Mailing Address - Street 1:1137 S SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-1108
Mailing Address - Country:US
Mailing Address - Phone:479-249-4234
Mailing Address - Fax:
Practice Address - Street 1:111 SE 22ND ST STE 11
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5180
Practice Address - Country:US
Practice Address - Phone:479-289-8465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPLD314133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education