Healthcare Provider Details

I. General information

NPI: 1487575304
Provider Name (Legal Business Name): ALEXIS MARIE MUSSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 VINEWOOD DR P.O BOX 2232
JULIAN CA
92036
US

IV. Provider business mailing address

3639 VINEWOOD DR P.O BOX 2232
JULIAN CA
92036
US

V. Phone/Fax

Practice location:
  • Phone: 858-723-2294
  • Fax:
Mailing address:
  • Phone: 858-723-2294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberY7516588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: