Healthcare Provider Details

I. General information

NPI: 1336676113
Provider Name (Legal Business Name): ALEXANDRA ELLEN RICHARDS MD, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-4502
US

IV. Provider business mailing address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

V. Phone/Fax

Practice location:
  • Phone: 310-319-1234
  • Fax:
Mailing address:
  • Phone: 310-319-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP10172
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN189752
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN189752
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: