Healthcare Provider Details

I. General information

NPI: 1457963852
Provider Name (Legal Business Name): ALEXANDRIA VILLARREAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 E CAMELBACK RD UNIT 625
PHOENIX AZ
85016-3458
US

IV. Provider business mailing address

16028 N 74TH LN
PEORIA AZ
85382-1833
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-2024
  • Fax:
Mailing address:
  • Phone: 602-363-5802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number241883
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN241883
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: