Healthcare Provider Details

I. General information

NPI: 1780012435
Provider Name (Legal Business Name): ALEXANDRIA JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8775 AERO DR STE 132
SAN DIEGO CA
92123-1779
US

IV. Provider business mailing address

733 CORTE MANOLITO
SAN MARCOS CA
92069-7359
US

V. Phone/Fax

Practice location:
  • Phone: 858-609-8742
  • Fax:
Mailing address:
  • Phone: 505-414-5972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038974
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN-77769
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95102784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: