Healthcare Provider Details

I. General information

NPI: 1508395765
Provider Name (Legal Business Name): ALEXANDER SPENCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 06/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD STE 202
SALINAS CA
93906-3127
US

IV. Provider business mailing address

1012 OLYMPIC LN
SEASIDE CA
93955-6224
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: