Provider Demographics
NPI:1487890018
Name:FOOTE, ALYSON C (RD)
Entity type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:C
Last Name:FOOTE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33851 PLUM TREE LN
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2267
Mailing Address - Country:US
Mailing Address - Phone:909-795-8892
Mailing Address - Fax:
Practice Address - Street 1:255 TERRACINA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4870
Practice Address - Country:US
Practice Address - Phone:909-435-5482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-03
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA929843133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered