Healthcare Provider Details

I. General information

NPI: 1255949269
Provider Name (Legal Business Name): ALEXANDRIA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N PERRIS BLVD
PERRIS CA
92571-2811
US

IV. Provider business mailing address

555 N PERRIS BLVD
PERRIS CA
92571-2811
US

V. Phone/Fax

Practice location:
  • Phone: 951-436-5300
  • Fax:
Mailing address:
  • Phone: 951-436-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: