Healthcare Provider Details

I. General information

NPI: 1679896864
Provider Name (Legal Business Name): ALEXANDRA CHANNING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
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: 760-760-4170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA114207
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number57388
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number283579
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: