Healthcare Provider Details

I. General information

NPI: 1710825229
Provider Name (Legal Business Name): ALEXANDER URLOGSON LE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEX URLOGSON LE

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 S MELROSE DR STE B #120
VISTA CA
92081-2404
US

IV. Provider business mailing address

1605 S MELROSE DR STE B SUITE 120
VISTA CA
92081-2404
US

V. Phone/Fax

Practice location:
  • Phone: 760-576-5051
  • Fax:
Mailing address:
  • Phone: 760-576-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberL10115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: