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NPI Code Detail

MEDICARE: ALEXIS OLSON BACHIEGA PHD

MEDICARE: ALEXIS OLSON BACHIEGA PHD
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
1103G00000XClinical Neuropsychologist30765CA
2103T00000XPsychologist30765CA

General Provider Information

NPI Number : 1912315037
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS OLSON BACHIEGA PHD
Provider Business Mailing Address
First Line : 3990 OLD TOWN AVE STE C303
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-2932
Country : US
Telephone Number : 858-964-0722
Fax Number : 866-437-0375
Provider Business Practice Location Address
First Line : 3990 OLD TOWN AVE STE C303
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-2932
Country : US
Telephone Number : 858-964-0722
Fax Number : 866-437-0375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2014
Last Update Date : 02/12/2026

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