Healthcare Provider Details

I. General information

NPI: 1134479785
Provider Name (Legal Business Name): CATHERINE A ALIX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MARENGO STREET
LOS ANGELES CA
90033
US

IV. Provider business mailing address

1954 E YALE ST APT. B
ONTARIO CA
91764-6806
US

V. Phone/Fax

Practice location:
  • Phone: 323-276-6400
  • Fax:
Mailing address:
  • Phone: 323-276-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number96163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: