Provider Demographics
NPI:1316499569
Name:ALEXANDER, ILEANA (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8568 SW 214TH WAY
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-7379
Mailing Address - Country:US
Mailing Address - Phone:786-205-9341
Mailing Address - Fax:
Practice Address - Street 1:8568 SW 214TH WAY
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-7379
Practice Address - Country:US
Practice Address - Phone:786-205-9341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7998133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered