Healthcare Provider Details

I. General information

NPI: 1063770980
Provider Name (Legal Business Name): CARLY ALEXANDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N LARCHMONT BLVD STE 1020
LOS ANGELES CA
90004-6410
US

IV. Provider business mailing address

1547 TALMADGE ST
LOS ANGELES CA
90027-1534
US

V. Phone/Fax

Practice location:
  • Phone: 323-960-8500
  • Fax:
Mailing address:
  • Phone: 612-816-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number148954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: