Healthcare Provider Details

I. General information

NPI: 1629524947
Provider Name (Legal Business Name): ALEXANDRIA TILLEY PPS, OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25862 ANTONIO PKWY
RANCHO SANTA MARGARITA CA
92688-5541
US

IV. Provider business mailing address

25862 ANTONIO PKWY
RANCHO SANTA MARGARITA CA
92688-5541
US

V. Phone/Fax

Practice location:
  • Phone: 949-589-6935
  • Fax:
Mailing address:
  • Phone: 949-589-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number230148392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: