MEDICARE: MS. ALESSANDARA KITISHIAN R. D.

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
1	133V00000X	Registered Dietitian	85007784	CA

General Provider Information

NPI Number	:	1902111289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALESSANDARA KITISHIAN R. D.

Provider Business Mailing Address
First Line	:	FILE # 54433
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-4433
Country	:	US
Telephone Number	:	858-784-5888
Fax Number	:

Provider Business Practice Location Address
First Line	:	9894 GENESEE AVE
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-1296
Country	:	US
Telephone Number	:	858-626-5066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	08/11/2010

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