Healthcare Provider Details

I. General information

NPI: 1083538284
Provider Name (Legal Business Name): ALEXANDRA CHANNING MD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 S MELROSE DR STE 104
VISTA CA
92081-8789
US

IV. Provider business mailing address

2305 S MELROSE DR STE 104
VISTA CA
92081-8789
US

V. Phone/Fax

Practice location:
  • Phone: 760-760-4170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA CHANNING
Title or Position: PRESIDENT
Credential: MD
Phone: 760-760-4170