Healthcare Provider Details

I. General information

NPI: 1609359686
Provider Name (Legal Business Name): ALEXIS HEALTHCARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 FIELD
IRVINE CA
92620-3345
US

IV. Provider business mailing address

35 FIELD
IRVINE CA
92620-3345
US

V. Phone/Fax

Practice location:
  • Phone: 949-981-4515
  • Fax:
Mailing address:
  • Phone: 949-981-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: KO G LIUO
Title or Position: NP
Credential: NP
Phone: 949-981-4515