Healthcare Provider Details

I. General information

NPI: 1902411135
Provider Name (Legal Business Name): ALEXANDRA ANDREA KUZMIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SNEATH LN STE 200
SAN BRUNO CA
94066-2349
US

IV. Provider business mailing address

808 LA MONTAGNE PL
SOUTH SAN FRANCISCO CA
94080-7341
US

V. Phone/Fax

Practice location:
  • Phone: 916-382-4447
  • Fax:
Mailing address:
  • Phone: 415-696-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: