MEDICARE: DR. ALEXIS RONCEVICH

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
1	103T00000X	Psychologist	PY61551114	WA
2	103T00000X	Psychologist	PSY36283	CA

General Provider Information

NPI Number	:	1689123150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS RONCEVICH

Provider Business Mailing Address
First Line	:	2093 SILVERADO ST
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-3201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9246 LIGHTWAVE AVE STE 120
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-6411
Country	:	US
Telephone Number	:	800-270-5016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	04/05/2026

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Directions to “ DR. ALEXIS RONCEVICH ” Practice Location

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