Provider Demographics
NPI:1598167140
Name:BRUEHL, ALEXANDRA M (LAC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:M
Last Name:BRUEHL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 N VENDOME ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2833
Mailing Address - Country:US
Mailing Address - Phone:323-484-4560
Mailing Address - Fax:
Practice Address - Street 1:4306 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-3511
Practice Address - Country:US
Practice Address - Phone:323-484-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16160171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist