Healthcare Provider Details

I. General information

NPI: 1629477492
Provider Name (Legal Business Name): ALINE ALEXANDRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 PARK ST
ALAMEDA CA
94501-4507
US

IV. Provider business mailing address

4051 HEMINGWAY CMN
FREMONT CA
94536-6028
US

V. Phone/Fax

Practice location:
  • Phone: 925-922-9595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY34725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: