Healthcare Provider Details

I. General information

NPI: 1477975456
Provider Name (Legal Business Name): CHRISTINA MARIA VERGARA ALESHIRE RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 PROFESSIONAL CT
LAS VEGAS NV
89128-0825
US

IV. Provider business mailing address

PO BOX 36310
LAS VEGAS NV
89133-6310
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-1599
  • Fax: 702-240-4962
Mailing address:
  • Phone: 702-382-1599
  • Fax: 702-240-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number32293DI-0
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: