Provider Demographics
NPI:1417186040
Name:ALEXANDER, MARILYN LOUISE (BA, MAT)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:LOUISE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:BA, MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 HARVARD ST
Mailing Address - Street 2:5
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2435
Mailing Address - Country:US
Mailing Address - Phone:310-829-5916
Mailing Address - Fax:
Practice Address - Street 1:1321 HARVARD ST
Practice Address - Street 2:5
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2435
Practice Address - Country:US
Practice Address - Phone:310-829-5916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 1733225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist