Healthcare Provider Details

I. General information

NPI: 1053066464
Provider Name (Legal Business Name): ALEXANDRA JAZMINE PRECIADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 LOGAN AVE
SAN DIEGO CA
92113-2411
US

IV. Provider business mailing address

2865 LOGAN AVE
SAN DIEGO CA
92113-2411
US

V. Phone/Fax

Practice location:
  • Phone: 619-232-4357
  • Fax: 619-232-7048
Mailing address:
  • Phone: 619-232-4357
  • Fax: 619-232-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: