Healthcare Provider Details

I. General information

NPI: 1245666387
Provider Name (Legal Business Name): ALEXANDRA GABBARD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA BROWN DPT

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3323 CARMEL MOUNTAIN RD SUITE 200
SAN DIEGO CA
92121-1035
US

IV. Provider business mailing address

3959 RUFFIN RD SUITE J
SAN DIEGO CA
92123-1830
US

V. Phone/Fax

Practice location:
  • Phone: 858-720-0991
  • Fax: 858-720-0992
Mailing address:
  • Phone: 858-279-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 40556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: