Healthcare Provider Details

I. General information

NPI: 1306670252
Provider Name (Legal Business Name): AMY MICHELLE ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 ARLINGTON AVE STE D
RIVERSIDE CA
92504-1966
US

IV. Provider business mailing address

8171 BON VIEW DR
RIVERSIDE CA
92508-6158
US

V. Phone/Fax

Practice location:
  • Phone: 951-907-0489
  • Fax:
Mailing address:
  • Phone: 951-907-0489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: