Provider Demographics
NPI:1942981212
Name:WILLIAMS, ALEJANDRA JASMINE
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:JASMINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEJANDRA
Other - Middle Name:JASMINE
Other - Last Name:AVALOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9601 ARLETA AVE
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-4649
Mailing Address - Country:US
Mailing Address - Phone:818-448-0239
Mailing Address - Fax:
Practice Address - Street 1:1530 HILLHURST AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5516
Practice Address - Country:US
Practice Address - Phone:323-644-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily