Provider Demographics
NPI:1427520592
Name:ALAI, NICOLE LALEH (MS, RD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LALEH
Last Name:ALAI
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9331 DARROW DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7230
Mailing Address - Country:US
Mailing Address - Phone:714-721-9057
Mailing Address - Fax:
Practice Address - Street 1:7677 CENTER AVE STE 310
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9119
Practice Address - Country:US
Practice Address - Phone:714-379-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-29
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86037825133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty