Healthcare Provider Details

I. General information

NPI: 1972149532
Provider Name (Legal Business Name): TAZSA MICHELLE ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15456 W SAGE ST
VICTORVILLE CA
92392-2346
US

IV. Provider business mailing address

15456 W SAGE ST
VICTORVILLE CA
92392-2346
US

V. Phone/Fax

Practice location:
  • Phone: 818-497-9260
  • Fax: 818-717-1000
Mailing address:
  • Phone: 818-497-9260
  • Fax: 818-717-1000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: