Healthcare Provider Details

I. General information

NPI: 1457971459
Provider Name (Legal Business Name): ALEJANDRA IZAGUIRRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E COLORADO BLVD STE 560
PASADENA CA
91106-2380
US

IV. Provider business mailing address

233 HOSKINS MILL LN APT D
CHARLOTTE NC
28208-1486
US

V. Phone/Fax

Practice location:
  • Phone: 888-805-0759
  • Fax:
Mailing address:
  • Phone: 919-450-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: