Healthcare Provider Details

I. General information

NPI: 1629693098
Provider Name (Legal Business Name): ALEXI JOSEPH KRYGIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12818 HEACOCK ST
MORENO VALLEY CA
92553-3165
US

IV. Provider business mailing address

12244 18TH ST
YUCAIPA CA
92399-1581
US

V. Phone/Fax

Practice location:
  • Phone: 951-247-6542
  • Fax:
Mailing address:
  • Phone: 909-708-7962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: