Healthcare Provider Details

I. General information

NPI: 1225417322
Provider Name (Legal Business Name): ATHENA THERESA ALEXANDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 E 17TH ST STE 101
SANTA ANA CA
92701-2641
US

IV. Provider business mailing address

1206 E 17TH ST STE 101
SANTA ANA CA
92701-2641
US

V. Phone/Fax

Practice location:
  • Phone: 714-352-2911
  • Fax: 714-352-2903
Mailing address:
  • Phone: 714-352-2911
  • Fax: 714-352-2903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA135990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: