Healthcare Provider Details

I. General information

NPI: 1255807962
Provider Name (Legal Business Name): ALEXA BRIELLE MARR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47950 DUNE PALMS RD
LA QUINTA CA
92253-4000
US

IV. Provider business mailing address

79140 FALMOUTH DR
BERMUDA DUNES CA
92203-1534
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-4200
  • Fax:
Mailing address:
  • Phone: 760-972-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: