Healthcare Provider Details

I. General information

NPI: 1124413547
Provider Name (Legal Business Name): ALYSSA PAGLIA RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3549 MARIPOSA ST
DENVER CO
80211-3044
US

IV. Provider business mailing address

3549 MARIPOSA ST
DENVER CO
80211-3044
US

V. Phone/Fax

Practice location:
  • Phone: 970-343-4368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1100
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number7678
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: