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General NPI Number Information
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NPI Number | 1447633292
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Entity Type | Individual
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Provider Name | ALEXIS BUCKLEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 1201 N 35TH AVE STE 200
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5434
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Country | US
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Telephone | 954-987-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 9350 THE RESORT PKWY UNIT 5811
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-9245
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | ME175099
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License Number State | FL
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