Healthcare Provider Details

I. General information

NPI: 1710340716
Provider Name (Legal Business Name): ALEXANDRA TSONTAKIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W THOMAS RD STE 250
PHOENIX AZ
85013-4215
US

IV. Provider business mailing address

PO BOX 33269
PHOENIX AZ
85067-3269
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3520
  • Fax: 602-406-6162
Mailing address:
  • Phone: 602-406-4786
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57855
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: