Provider Demographics
NPI:1427432251
Name:ALENCAR, MICHELLE KULOVITZ (PHD, CCN)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:KULOVITZ
Last Name:ALENCAR
Suffix:
Gender:F
Credentials:PHD, CCN
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KULOVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, CCN
Mailing Address - Street 1:836 S AMBER LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4826
Mailing Address - Country:US
Mailing Address - Phone:714-809-8528
Mailing Address - Fax:
Practice Address - Street 1:836 S AMBER LN
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4826
Practice Address - Country:US
Practice Address - Phone:714-809-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5057133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5057OtherCLINICAL NUTRITON CERTIFICATION BOARD