Provider Demographics
NPI:1194503078
Name:MACLEAN, ALEXANDRA BAILEY (RD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:BAILEY
Last Name:MACLEAN
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 1:1200 DINCARA RD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-3100
Mailing Address - Country:US
Mailing Address - Phone:818-269-1048
Mailing Address - Fax:
Practice Address - Street 1:1200 DINCARA RD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-3100
Practice Address - Country:US
Practice Address - Phone:818-269-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86298608133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered