Healthcare Provider Details

I. General information

NPI: 1336227727
Provider Name (Legal Business Name): DR. ALEXANDRA N. CHASE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 EUREKA SQ STE 213
PACIFICA CA
94044-2677
US

IV. Provider business mailing address

544 VISTA MAR AVE
PACIFICA CA
94044-1950
US

V. Phone/Fax

Practice location:
  • Phone: 650-302-1395
  • Fax: 650-355-6752
Mailing address:
  • Phone: 650-302-1395
  • Fax: 650-355-6752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY18562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: