Provider Demographics
NPI:1851382352
Name:MASCIANA, ALEXIS C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:C
Last Name:MASCIANA
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 1:499 N EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1347
Mailing Address - Country:US
Mailing Address - Phone:760-436-6000
Mailing Address - Fax:760-436-6000
Practice Address - Street 1:499 N EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1366
Practice Address - Country:US
Practice Address - Phone:760-436-6000
Practice Address - Fax:760-436-6000
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A812320Medicaid
CA00A812320Medicaid
CAWA81232AMedicare ID - Type Unspecified