Healthcare Provider Details

I. General information

NPI: 1720788425
Provider Name (Legal Business Name): TIANEE ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5956 SAN VICENTE BLVD APT 2
LOS ANGELES CA
90019-6669
US

IV. Provider business mailing address

1337 S RIDGELEY DR
LOS ANGELES CA
90019-2660
US

V. Phone/Fax

Practice location:
  • Phone: 323-559-5123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number743185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: