Provider Demographics
NPI:1417045089
Name:FOSTER, ALEXA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27001 LA PAZ RD
Mailing Address - Street 2:SUITE 336
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5502
Mailing Address - Country:US
Mailing Address - Phone:949-916-0711
Mailing Address - Fax:866-825-3417
Practice Address - Street 1:27001 LA PAZ RD
Practice Address - Street 2:SUITE 336
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5502
Practice Address - Country:US
Practice Address - Phone:949-916-0711
Practice Address - Fax:866-825-3417
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP18454Medicare ID - Type UnspecifiedPROVIDER ID