Provider Demographics
NPI:1700865417
Name:KOLLMEIER, ALEXA P (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:P
Last Name:KOLLMEIER
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 1:13754 MANGO DR UNIT 210
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3436
Mailing Address - Country:US
Mailing Address - Phone:858-523-0722
Mailing Address - Fax:
Practice Address - Street 1:10666 N TORREY PINES RD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1027
Practice Address - Country:US
Practice Address - Phone:858-554-6158
Practice Address - Fax:858-554-6123
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78045207RG0300X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A780450Medicaid
CAH79336Medicare UPIN
CA00A780450Medicaid