Provider Demographics
NPI:1477644185
Name:DIVINSKY, ALEXANDRA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:
Last Name:DIVINSKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:BOBRINEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 64455
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-0455
Mailing Address - Country:US
Mailing Address - Phone:310-477-7201
Mailing Address - Fax:
Practice Address - Street 1:11600 WILSHIRE BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5781
Practice Address - Country:US
Practice Address - Phone:310-477-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15115163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0800XNursing Service ProvidersRegistered NurseNeuroscience