Healthcare Provider Details

I. General information

NPI: 1609440783
Provider Name (Legal Business Name): ALEXANDRIA POE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SPRING ST STE 300
LA MESA CA
91942-0274
US

IV. Provider business mailing address

5025 COLLWOOD BLVD # 3215
SAN DIEGO CA
92115-2126
US

V. Phone/Fax

Practice location:
  • Phone: 619-782-0700
  • Fax:
Mailing address:
  • Phone: 707-679-8566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-179551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: