Provider Demographics
NPI:1073144861
Name:ALEXANDRU, MIRELLA
Entity Type:Individual
Prefix:
First Name:MIRELLA
Middle Name:
Last Name:ALEXANDRU
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 1:16236 SE TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-4056
Mailing Address - Country:US
Mailing Address - Phone:971-373-1258
Mailing Address - Fax:
Practice Address - Street 1:1313 NE 134TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2705
Practice Address - Country:US
Practice Address - Phone:360-518-6249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician