Healthcare Provider Details

I. General information

NPI: 1508574997
Provider Name (Legal Business Name): MISS ALEXIS NICOLE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 HOTEL CIR N STE 316
SAN DIEGO CA
92108-2803
US

IV. Provider business mailing address

2195 STATION VILLAGE WAY APT 1216
SAN DIEGO CA
92108-6529
US

V. Phone/Fax

Practice location:
  • Phone: 619-961-2120
  • Fax:
Mailing address:
  • Phone: 916-416-7929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number46-1305562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: