Healthcare Provider Details

I. General information

NPI: 1447025499
Provider Name (Legal Business Name): ALEXISNADA LOCK REID FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE 205
NEWPORT BEACH CA
92663-3667
US

IV. Provider business mailing address

240 AVENIDA VISTA MONTANA APT 14C
SAN CLEMENTE CA
92672-9439
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-1843
  • Fax:
Mailing address:
  • Phone: 202-236-6572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95026154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: