Provider Demographics
NPI:1437725371
Name:HUMPHREY, ALEXANDER ANTHONY (LVN)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:ANTHONY
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 CAMINO DEL RIO S STE 123
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3739
Mailing Address - Country:US
Mailing Address - Phone:619-275-8000
Mailing Address - Fax:
Practice Address - Street 1:2727 CAMINO DEL RIO S STE 123
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3739
Practice Address - Country:US
Practice Address - Phone:619-894-7376
Practice Address - Fax:619-810-2291
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA217753164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty