Healthcare Provider Details

I. General information

NPI: 1265104129
Provider Name (Legal Business Name): ALEXANDRIA MONIQUE GAMBRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35793 SEA SMOKE ST
WINCHESTER CA
92596-9144
US

IV. Provider business mailing address

35793 SEA SMOKE ST
WINCHESTER CA
92596-9144
US

V. Phone/Fax

Practice location:
  • Phone: 760-547-6929
  • Fax:
Mailing address:
  • Phone: 760-547-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT162434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: