Provider Demographics
NPI:1316640949
Name:VITANZA, ALEXANDRA (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:VITANZA
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2118
Mailing Address - Country:US
Mailing Address - Phone:440-781-7236
Mailing Address - Fax:
Practice Address - Street 1:1669 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2118
Practice Address - Country:US
Practice Address - Phone:440-781-7236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.10041133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered