Provider Demographics
NPI:1629143185
Name:ALEXANDER, DARYL PHYLLIS (MD)
Entity Type:Individual
Prefix:MRS
First Name:DARYL
Middle Name:PHYLLIS
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18370 BURBANK BLVD
Mailing Address - Street 2:#100
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2804
Mailing Address - Country:US
Mailing Address - Phone:818-776-0200
Mailing Address - Fax:818-343-3107
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:#100
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:818-776-0200
Practice Address - Fax:818-343-3107
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92314Medicare UPIN