Healthcare Provider Details

I. General information

NPI: 1073434213
Provider Name (Legal Business Name): ODETE ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 08/19/2026
Certification Date: 07/23/2026
Deactivation Date: 08/06/2026
Reactivation Date: 08/19/2026

III. Provider practice location address

3211 AUTO PLZ STE A
SAN PABLO CA
94806-1931
US

IV. Provider business mailing address

3211 AUTO PLZ STE A
SAN PABLO CA
94806-1931
US

V. Phone/Fax

Practice location:
  • Phone: 925-334-2289
  • Fax:
Mailing address:
  • Phone: 925-334-2289
  • Fax:

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: