Healthcare Provider Details

I. General information

NPI: 1649088428
Provider Name (Legal Business Name): ALEXANDER SENTURIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 WATSON DR
CLAREMONT CA
91711-4817
US

IV. Provider business mailing address

526 E PROVIDENCIA AVE
BURBANK CA
91501-2421
US

V. Phone/Fax

Practice location:
  • Phone: 909-607-7855
  • Fax:
Mailing address:
  • Phone: 310-266-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65785
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: