Provider Demographics
NPI:1932898731
Name:HIMES, ALYSSA GENNY (RDN)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:GENNY
Last Name:HIMES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 EZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-1427
Mailing Address - Country:US
Mailing Address - Phone:559-779-9449
Mailing Address - Fax:
Practice Address - Street 1:755 N PEACH AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-7247
Practice Address - Country:US
Practice Address - Phone:559-578-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86176909133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered