Healthcare Provider Details

I. General information

NPI: 1124950001
Provider Name (Legal Business Name): ALEXA BRITTON THEODORA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 CAMEO HIGHLANDS DR
CORONA DEL MAR CA
92625-2702
US

IV. Provider business mailing address

633 CAMEO HIGHLANDS DR
CORONA DEL MAR CA
92625-2702
US

V. Phone/Fax

Practice location:
  • Phone: 949-322-3481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number95391757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: