Provider Demographics
NPI:1598425134
Name:EGUCHI, ALEXA ELIZABETH
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:ELIZABETH
Last Name:EGUCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 ELDEN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1534
Mailing Address - Country:US
Mailing Address - Phone:949-241-0545
Mailing Address - Fax:
Practice Address - Street 1:2030 E 4TH ST STE 138F
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3920
Practice Address - Country:US
Practice Address - Phone:657-236-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130150106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist