Healthcare Provider Details

I. General information

NPI: 1942981212
Provider Name (Legal Business Name): ALEJANDRA JASMINE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEJANDRA JASMINE AVALOS

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 HILLHURST AVE
LOS ANGELES CA
90027-5516
US

IV. Provider business mailing address

9601 ARLETA AVE
ARLETA CA
91331-4649
US

V. Phone/Fax

Practice location:
  • Phone: 323-644-3880
  • Fax:
Mailing address:
  • Phone: 818-448-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: