Healthcare Provider Details

I. General information

NPI: 1154154870
Provider Name (Legal Business Name): ALEXANDRA METHRATTA PSY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 SHOREHAM PL STE 330
SAN DIEGO CA
92122-5976
US

IV. Provider business mailing address

18336 SOLEDAD CANYON RD PO BOX 1361
SANTA CLARITA CA
91386-3035
US

V. Phone/Fax

Practice location:
  • Phone: 877-840-6956
  • Fax: 619-383-6701
Mailing address:
  • Phone: 805-334-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36553
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0006297
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: