Healthcare Provider Details

I. General information

NPI: 1689093742
Provider Name (Legal Business Name): ALEXIA GHAZI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-5816
  • Fax: 719-776-5816
Mailing address:
  • Phone: 719-776-5816
  • Fax: 719-776-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberR5727
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberDR.0067080
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: