Healthcare Provider Details

I. General information

NPI: 1598375834
Provider Name (Legal Business Name): ALEXANDRA NICOLE MACEDO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2020
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9855 ERMA RD STE 133
SAN DIEGO CA
92131-1092
US

IV. Provider business mailing address

9855 ERMA RD STE 133
SAN DIEGO CA
92131-1092
US

V. Phone/Fax

Practice location:
  • Phone: 619-531-5800
  • Fax: 833-485-0482
Mailing address:
  • Phone: 619-531-5800
  • Fax: 833-485-0482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: