Provider Demographics
NPI:1366276453
Name:CRISS, ALONDRA S (MPH, RD, LD)
Entity type:Individual
Prefix:
First Name:ALONDRA
Middle Name:S
Last Name:CRISS
Suffix:
Gender:F
Credentials:MPH, 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:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-0104
Mailing Address - Country:US
Mailing Address - Phone:817-600-1205
Mailing Address - Fax:
Practice Address - Street 1:1657 OAK CREEK DR
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3344
Practice Address - Country:US
Practice Address - Phone:817-250-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
943763133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered