Provider Demographics
NPI:1881062354
Name:ALEGRIA, BRISA (RD, LD)
Entity type:Individual
Prefix:
First Name:BRISA
Middle Name:
Last Name:ALEGRIA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W ADSON RD
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8723
Mailing Address - Country:US
Mailing Address - Phone:907-414-0103
Mailing Address - Fax:
Practice Address - Street 1:1001 W ADSON RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8723
Practice Address - Country:US
Practice Address - Phone:907-414-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKDTND275133N00000X, 133VN1005X, 133VN1006X, 133V00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty