Healthcare Provider Details

I. General information

NPI: 1215494190
Provider Name (Legal Business Name): ALEXANDRA MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10666 N TORREY PINES RD # 200N
LA JOLLA CA
92037-1027
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD MAIL DROP 4S-205 IN ADDRESS 2 BOX
SAN DIEGO CA
92127
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-4310
  • Fax:
Mailing address:
  • Phone: 858-605-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number57326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: