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NPI Code Detail

MEDICARE: ALEXIS UNDERHILL RD

MEDICARE: ALEXIS UNDERHILL RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1215635818
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS UNDERHILL RD
Provider Business Mailing Address
First Line : 867 VISTA DEL MAR PL APT 203
Second Line :
City : VENTURA
State : CA
Zip : 93001-3711
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 400 MOBIL AVE STE D9
Second Line :
City : CAMARILLO
State : CA
Zip : 93010-6376
Country : US
Telephone Number : 805-738-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2023
Last Update Date : 07/18/2024

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