Healthcare Provider Details

I. General information

NPI: 1629789706
Provider Name (Legal Business Name): ALEXANDRA KUNESH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 MURPHYS GRADE RD
ANGELS CAMP CA
95222-9133
US

IV. Provider business mailing address

323 S MAIN ST PO BOX 7000/21
ANGELS CAMP CA
95221
US

V. Phone/Fax

Practice location:
  • Phone: 209-736-2507
  • Fax: 209-736-8383
Mailing address:
  • Phone: 209-736-2507
  • Fax: 209-736-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15551
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number15551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: