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NPI Code Detail

MEDICARE: ALEXANDRA BOZICK

MEDICARE: ALEXANDRA BOZICK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2101YA0400XAddiction (Substance Use Disorder) CounselorCA

General Provider Information

NPI Number : 1306327325
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA BOZICK
Provider Business Mailing Address
First Line : 12 LA MIRAGE CIR
Second Line :
City : ALISO VIEJO
State : CA
Zip : 92656-5250
Country : US
Telephone Number : 760-969-2143
Fax Number :
Provider Business Practice Location Address
First Line : 1207 E FRUIT ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92701-4206
Country : US
Telephone Number : 714-953-9373
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2018
Last Update Date : 12/03/2019

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Directions to “ ALEXANDRA BOZICK ” Practice Location

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