Provider Demographics
NPI:1982452629
Name:HENDERSHOT, ALEEZA (RDN)
Entity Type:Individual
Prefix:
First Name:ALEEZA
Middle Name:
Last Name:HENDERSHOT
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 1:514 N CLEMENTINE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2548
Mailing Address - Country:US
Mailing Address - Phone:909-702-5303
Mailing Address - Fax:
Practice Address - Street 1:514 N CLEMENTINE ST APT 3
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2548
Practice Address - Country:US
Practice Address - Phone:909-702-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86150613133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered