Healthcare Provider Details

I. General information

NPI: 1013677749
Provider Name (Legal Business Name): ALEXANDRA HUTCHISON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 BAKER ST STE A
COSTA MESA CA
92626-3752
US

IV. Provider business mailing address

1530 BAKER ST STE A
COSTA MESA CA
92626-3752
US

V. Phone/Fax

Practice location:
  • Phone: 714-559-5436
  • Fax:
Mailing address:
  • Phone: 714-559-5436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95019307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: