Healthcare Provider Details

I. General information

NPI: 1336316421
Provider Name (Legal Business Name): ALEXANDRA LEE GONZALEZ AGUILAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 S EASTERN AVE STE 209
HENDERSON NV
89052-3908
US

IV. Provider business mailing address

PO BOX 33269
PHOENIX AZ
85067-3269
US

V. Phone/Fax

Practice location:
  • Phone: 702-616-5865
  • Fax: 702-616-5828
Mailing address:
  • Phone: 602-406-4786
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15377
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number15377
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: