Healthcare Provider Details

I. General information

NPI: 1437537412
Provider Name (Legal Business Name): SERGE ALEXANIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 WESTWOOD BLVD STE. 730
LOS ANGELES CA
90095-1732
US

IV. Provider business mailing address

5767 W CENTURY BLVD 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-3563
  • Fax:
Mailing address:
  • Phone: 310-301-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA111292
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberA111292
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA111292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: