Healthcare Provider Details

I. General information

NPI: 1508714015
Provider Name (Legal Business Name): ALEXA MIERA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15454 GALE AVE STE F
HACIENDA HEIGHTS CA
91745-1500
US

IV. Provider business mailing address

3612 E MOONLIGHT ST UNIT 99
ONTARIO CA
91761-2793
US

V. Phone/Fax

Practice location:
  • Phone: 626-269-3040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: