1336272905 NPI number — MS. DEBORAH SUSAN ALEXANDER

Table of content: MS. DEBORAH SUSAN ALEXANDER (NPI 1336272905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336272905 NPI number — MS. DEBORAH SUSAN ALEXANDER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEXANDER
Provider First Name:
DEBORAH
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336272905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 15TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90402-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-393-1243
Provider Business Mailing Address Fax Number:
310-393-3013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1533 EUCLID ST
Provider Second Line Business Practice Location Address:
FAMILY SERVICE OF SANTA MONICA
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90404-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-451-9747
Provider Business Practice Location Address Fax Number:
310-451-6156
Provider Enumeration Date:
03/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS10641 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)