Healthcare Provider Details

I. General information

NPI: 1235615428
Provider Name (Legal Business Name): ASHLEY NICHOLE ALEXIS ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 PARKWAY DR STE 117
LA MESA CA
91942-1534
US

IV. Provider business mailing address

2305 S MELROSE DR STE 105
VISTA CA
92081-8789
US

V. Phone/Fax

Practice location:
  • Phone: 619-772-1164
  • Fax:
Mailing address:
  • Phone: 760-542-8898
  • Fax: 760-542-3158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: