Provider Demographics
NPI:1013543008
Name:MARA, ALEX CHOI (NP-C)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:CHOI
Last Name:MARA
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5248 ZEPHYR LN UNIT 24
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2749
Mailing Address - Country:US
Mailing Address - Phone:858-766-8853
Mailing Address - Fax:
Practice Address - Street 1:5248 ZEPHYR LN UNIT 24
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2749
Practice Address - Country:US
Practice Address - Phone:858-766-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-21
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty