Provider Demographics
NPI:1831675149
Name:CESAR, ALEXANDRA
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:CESAR
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 1:6136 BARKER LNDG
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-9521
Mailing Address - Country:US
Mailing Address - Phone:786-512-5888
Mailing Address - Fax:
Practice Address - Street 1:3900 MEMORIAL COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-2406
Practice Address - Country:US
Practice Address - Phone:404-292-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103TF0000X, 171R00000X, 224Z00000X, 225X00000X, 385HR2050X, 385HR2065X
GA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No171R00000XOther Service ProvidersInterpreter
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child