Provider Demographics
NPI:1902867823
Name:MESSINA, ALEX JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:JOHN
Last Name:MESSINA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2021 SANTA MONICA BLVD
Mailing Address - Street 2:STE 101E
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-453-1103
Mailing Address - Fax:310-453-9633
Practice Address - Street 1:2021 SANTA MONICA BLVD
Practice Address - Street 2:#101E
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-453-1103
Practice Address - Fax:310-453-9633
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA23984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A23984OtherSTATE LICENSE NUMBER
952845053OtherFED TAX ID NO
AM7460330OtherDEA
B49967Medicare UPIN