Healthcare Provider Details

I. General information

NPI: 1528678588
Provider Name (Legal Business Name): EDWARD A ALEXANDER ,MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10940 WILSHIRE BLVD
LOS ANGELES CA
90024-3915
US

IV. Provider business mailing address

4460 OVERLAND AVE APT 42
CULVER CITY CA
90230-4149
US

V. Phone/Fax

Practice location:
  • Phone: 310-753-2931
  • Fax:
Mailing address:
  • Phone: 310-753-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD A ALEXANDER SR.
Title or Position: PHYSICIAN
Credential: MD
Phone: 310-753-2931