Healthcare Provider Details

I. General information

NPI: 1083547848
Provider Name (Legal Business Name): ALEXANDRA NICOLE SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 WOODRUFF AVE STE 211
LONG BEACH CA
90808-2149
US

IV. Provider business mailing address

5833 E MONLACO RD
LONG BEACH CA
90808-2752
US

V. Phone/Fax

Practice location:
  • Phone: 424-228-6963
  • Fax:
Mailing address:
  • Phone: 562-335-9374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: