Healthcare Provider Details

I. General information

NPI: 1114556321
Provider Name (Legal Business Name): ALEXIA TATEM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISADERO ST RM C250
SAN FRANCISCO CA
94143-3010
US

IV. Provider business mailing address

1600 DIVISADERO ST RM C250
SAN FRANCISCO CA
94143-3010
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA186605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: