Provider Demographics
NPI:1013577816
Name:HAIDARIS, ALEXANDRA JOY
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JOY
Last Name:HAIDARIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5670 SW ERICKSON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3892
Mailing Address - Country:US
Mailing Address - Phone:650-338-6872
Mailing Address - Fax:
Practice Address - Street 1:4660 NE BELKNAP CT STE 217
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-8401
Practice Address - Country:US
Practice Address - Phone:971-864-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist