Basic Information
| Provider Information | |||||||||
| NPI: | 1538418454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALIAGA | ||||||||
| FirstName: | LETICIA | ||||||||
| MiddleName: | TANIA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | RD, CDE, CDR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 765 PARK PLACE | ||||||||
| Address2: | 4B | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176072015 | ||||||||
| FaxNumber: | 6467708405 | ||||||||
| Practice Location | |||||||||
| Address1: | 1824 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100353832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122065200 | ||||||||
| FaxNumber: | 6467708405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2012 | ||||||||
| LastUpdateDate: | 06/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 944798 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.