Healthcare Provider Details

I. General information

NPI: 1760099097
Provider Name (Legal Business Name): ELLEN M ALONSO STREET MS, R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELLEN M STREET MS, R.D.

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 BONITA AVE # 208
BERKELEY CA
94704-1014
US

IV. Provider business mailing address

1918 BONITA AVE # 208
BERKELEY CA
94704-1014
US

V. Phone/Fax

Practice location:
  • Phone: 510-671-1454
  • Fax: 707-596-7997
Mailing address:
  • Phone: 510-671-1454
  • Fax: 707-596-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86176658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: