Healthcare Provider Details

I. General information

NPI: 1891297073
Provider Name (Legal Business Name): EMILY L ALEXIADIS ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18370 BURBANK BLVD STE 414
TARZANA CA
91356-2843
US

IV. Provider business mailing address

24210 AMARYLLIS CT
VALENCIA CA
91354-1210
US

V. Phone/Fax

Practice location:
  • Phone: 818-506-3384
  • Fax: 818-774-2298
Mailing address:
  • Phone: 661-702-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number641934
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4628
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95007351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: