Healthcare Provider Details

I. General information

NPI: 1427556596
Provider Name (Legal Business Name): ALEXANDER TERRENCE SYKORA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50249 HARRISON ST STE K
COACHELLA CA
92236-1530
US

IV. Provider business mailing address

40300 WASHINGTON STREET I102
BERMUDA DUNES CA
92203
US

V. Phone/Fax

Practice location:
  • Phone: 760-393-0555
  • Fax: 760-393-0522
Mailing address:
  • Phone: 760-545-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95008332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: