MEDICARE: ALEXIS TARAE WASHINGTON LVN / NHA

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	3140N1450X	Pediatric Skilled Nursing Facility

General Provider Information

NPI Number	:	1861145807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS TARAE WASHINGTON LVN / NHA

Provider Business Mailing Address
First Line	:	1003 E HELMICK ST
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90746-3039
Country	:	US
Telephone Number	:	310-386-4626
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 E HELMICK ST
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90746-3039
Country	:	US
Telephone Number	:	310-386-4626
Fax Number	:

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

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	01/31/2022

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