Healthcare Provider Details

I. General information

NPI: 1427368919
Provider Name (Legal Business Name): ALISSA MARIE HERRERA RD (REGISTERED DIETI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISSA MARIE JOHNSON

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RADY CHILDREN'S HOSPITAL 3020 CHILDREN'S WAY CLINICAL NUTRITION DEPARTMENT
SAN DIEGO CA
92123
US

IV. Provider business mailing address

RADY CHILDREN'S HOSPITAL CLINICAL NUTRITION DEPARTMENT 3020 CHILDREN'S WAY
SAN DIEGO CA
92123
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-1700
  • Fax:
Mailing address:
  • Phone: 858-576-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number01049717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: