Provider Demographics
NPI:1467234849
Name:TSITSUASHVILI, ALEXANDRA (CLC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:TSITSUASHVILI
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 S WOOSTER ST APT 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1736
Mailing Address - Country:US
Mailing Address - Phone:818-554-7850
Mailing Address - Fax:
Practice Address - Street 1:824 S WOOSTER ST APT 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1736
Practice Address - Country:US
Practice Address - Phone:818-554-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA340070174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN