Provider Demographics
NPI:1205534906
Name:BALISTRERI, ANGELICA KARINA (RDN)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:KARINA
Last Name:BALISTRERI
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 N GRAND CANYON DR UNIT 2155
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-3735
Mailing Address - Country:US
Mailing Address - Phone:702-858-0495
Mailing Address - Fax:
Practice Address - Street 1:8250 N GRAND CANYON DR UNIT 2155
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-3735
Practice Address - Country:US
Practice Address - Phone:702-858-0495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39876-DI-2133V00000X
NV133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered