Provider Demographics
NPI:1922806314
Name:WIESELER, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:WIESELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:LYNN
Other - Last Name:D'SYLVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPH, RDN
Mailing Address - Street 1:7175 WINTERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7175 WINTERWOOD LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5420
Practice Address - Country:US
Practice Address - Phone:909-936-4576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86292259133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered