Healthcare Provider Details

I. General information

NPI: 1376191254
Provider Name (Legal Business Name): ALEXA KOOMLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 SHADELANDS DR BLDG 10
WALNUT CREEK CA
94598-2538
US

IV. Provider business mailing address

803 MORENO RD
SANTA BARBARA CA
93103-1804
US

V. Phone/Fax

Practice location:
  • Phone: 855-843-2476
  • Fax:
Mailing address:
  • Phone: 559-718-7092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: