Provider Demographics
NPI:1073151825
Name:SPOONER, ALEXANDRA BROOKE (PA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:BROOKE
Last Name:SPOONER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 S FAIR OAKS AVE STE 270
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2668
Practice Address - Country:US
Practice Address - Phone:424-314-0177
Practice Address - Fax:424-314-0180
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA57159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant