Provider Demographics
NPI:1891297073
Name:ALEXIADIS, EMILY L (ACNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:L
Last Name:ALEXIADIS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24210 AMARYLLIS CT
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1210
Mailing Address - Country:US
Mailing Address - Phone:661-702-0709
Mailing Address - Fax:
Practice Address - Street 1:18370 BURBANK BLVD STE 414
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2843
Practice Address - Country:US
Practice Address - Phone:818-506-3384
Practice Address - Fax:818-774-2298
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA641934163WC0200X
CA4628364S00000X
CA95007351363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist