Healthcare Provider Details

I. General information

NPI: 1679409585
Provider Name (Legal Business Name): ALEXANDRA CEJA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 W ENCANTO BLVD
PHOENIX AZ
85037-4202
US

IV. Provider business mailing address

14200 RUNNYMEDE ST
VAN NUYS CA
91405-1435
US

V. Phone/Fax

Practice location:
  • Phone: 623-907-5270
  • Fax:
Mailing address:
  • Phone: 818-389-1184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberS21101350
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: