Healthcare Provider Details

I. General information

NPI: 1609403492
Provider Name (Legal Business Name): KAYLA RENEE ALUISE RD, CSO, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 11/27/2023
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

13250 OLD HICKORY CT
NORTH LIMA OH
44452-8527
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-8030
  • Fax: 330-480-8049
Mailing address:
  • Phone: 330-831-1806
  • Fax: 330-480-8049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License NumberLD.6910
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: