Provider Demographics
NPI:1578835138
Name:FRESQUEZ, ALEXANDRA NUGENT (DPT)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:NUGENT
Last Name:FRESQUEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1502
Mailing Address - Country:US
Mailing Address - Phone:714-307-2543
Mailing Address - Fax:
Practice Address - Street 1:300 S HARBOR BLVD
Practice Address - Street 2:SUITE 710
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3733
Practice Address - Country:US
Practice Address - Phone:800-561-5207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-29
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist