Provider Demographics
NPI:1184007254
Name:ALEXANDRA A CHRYSANTHIS M D INC
Entity Type:Organization
Organization Name:ALEXANDRA A CHRYSANTHIS M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHRYSANTHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-795-6406
Mailing Address - Street 1:10861 CHERRY ST # 210
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5402
Mailing Address - Country:US
Mailing Address - Phone:562-795-6406
Mailing Address - Fax:562-795-6409
Practice Address - Street 1:10861 CHERRY ST # 210
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5402
Practice Address - Country:US
Practice Address - Phone:562-795-6406
Practice Address - Fax:562-795-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62293261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care