Healthcare Provider Details

I. General information

NPI: 1952382046
Provider Name (Legal Business Name): LAURA ELISE ALEXANDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ELISE CROTTY M.D.

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR # 0687 CMME ROOM 1088
LA JOLLA CA
92093-0687
US

IV. Provider business mailing address

5222 FONTAINE ST
SAN DIEGO CA
92120-1228
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-9760
  • Fax: 858-534-5611
Mailing address:
  • Phone: 619-438-4207
  • Fax: 858-534-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number226063
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA104176
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA104176
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA104176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: