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General NPI Number Information
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NPI Number | 1497127278
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Entity Type | Individual
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Provider Name | XIOMARA ALEXIS TERRELONGE PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 155 N SAN VICENTE BLVD
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2303
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Country | US
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Telephone | 310-870-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 155 N SAN VICENTE BLVD
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2303
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Country | US
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Telephone | 310-870-0400
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 019239
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.PA.70070969
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 58185
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License Number State | CA
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