Healthcare Provider Details

I. General information

NPI: 1588378368
Provider Name (Legal Business Name): ALEXIS ARLENE MAYAGOITIA BSN, RN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N STATE ST
LOS ANGELES CA
90033-5000
US

IV. Provider business mailing address

2300 N INDIANA AVE
LOS ANGELES CA
90032-3623
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-3000
  • Fax:
Mailing address:
  • Phone: 323-382-6503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: