Healthcare Provider Details

I. General information

NPI: 1609407402
Provider Name (Legal Business Name): ALEXANDER LUIS INTERIANO MSN, APRN, NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 W 6TH ST STE 200
LOS ANGELES CA
90020-5108
US

IV. Provider business mailing address

3630 MARATHON ST APT 301
LOS ANGELES CA
90026-2868
US

V. Phone/Fax

Practice location:
  • Phone: 213-235-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95013791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: