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NPI Code Detail

MEDICARE: NICHOLAS CHARLES ALEXANDER

MEDICARE: NICHOLAS CHARLES ALEXANDER
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
1171M00000XCase Manager/Care Coordinator5846CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15846OTHERCACAS REGISTRATION

General Provider Information

NPI Number : 1578766713
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS CHARLES ALEXANDER
Provider Business Mailing Address
First Line : 6107 ALVISO AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90043-3625
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5115 W ADAMS BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90016-2727
Country : US
Telephone Number : 323-296-4411
Fax Number : 323-933-5973
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2007
Last Update Date : 07/08/2007

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Directions to “ NICHOLAS CHARLES ALEXANDER ” Practice Location

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