Provider Demographics
NPI:1306001698
Name:ISPAS, ALEXANDRA (PSYD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:ISPAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 WINTERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5233
Mailing Address - Country:US
Mailing Address - Phone:925-487-8455
Mailing Address - Fax:
Practice Address - Street 1:2827 CONCORD BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2608
Practice Address - Country:US
Practice Address - Phone:925-685-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24084103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist