Provider Demographics
NPI:1619489192
Name:RHODEN, ALEXIS CHANEL (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:CHANEL
Last Name:RHODEN
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:CHANEL
Other - Last Name:RHODEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED HAIR LOSS
Mailing Address - Street 1:4931 OCEAN VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-2036
Mailing Address - Country:US
Mailing Address - Phone:619-200-3186
Mailing Address - Fax:619-262-6115
Practice Address - Street 1:8818 LA MESA BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-5407
Practice Address - Country:US
Practice Address - Phone:619-200-3186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD36914691744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management