Healthcare Provider Details

I. General information

NPI: 1962171470
Provider Name (Legal Business Name): ALEXANDRA HOTETZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 E HIGHLAND AVE
PATTON CA
92369-7813
US

IV. Provider business mailing address

3102 E HIGHLAND AVE
PATTON CA
92369-7813
US

V. Phone/Fax

Practice location:
  • Phone: 909-672-6329
  • Fax:
Mailing address:
  • Phone: 909-672-6329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: