Healthcare Provider Details

I. General information

NPI: 1750878054
Provider Name (Legal Business Name): ALEXANDRA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 MARKET ST
SAN DIEGO CA
92102-3241
US

IV. Provider business mailing address

865 3RD AVE STE 121
CHULA VISTA CA
91911-1300
US

V. Phone/Fax

Practice location:
  • Phone: 619-236-9492
  • Fax:
Mailing address:
  • Phone: 619-934-5770
  • Fax: 619-391-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: