Provider Demographics
NPI:1093925182
Name:ALEXANDRIDIS, ALEXIS REGINA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:REGINA
Last Name:ALEXANDRIDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 PERKINS ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6954
Mailing Address - Country:US
Mailing Address - Phone:707-938-7690
Mailing Address - Fax:707-581-1700
Practice Address - Street 1:246 PERKINS ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6954
Practice Address - Country:US
Practice Address - Phone:707-938-7690
Practice Address - Fax:707-581-1700
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL15958208600000X
CAC151087208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery