Healthcare Provider Details

I. General information

NPI: 1497550743
Provider Name (Legal Business Name): ALEXIS JANE LA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 JERONIMO RD
IRVINE CA
92618-1908
US

IV. Provider business mailing address

9401 JERONIMO RD
IRVINE CA
92618-1908
US

V. Phone/Fax

Practice location:
  • Phone: 714-744-7650
  • Fax:
Mailing address:
  • Phone: 714-744-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: