Provider Demographics
NPI:1255378303
Name:ALEXANDER, MAGDI G (FACS)
Entity type:Individual
Prefix:DR
First Name:MAGDI
Middle Name:G
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BELLEFONTAINE ST STE 409
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3132
Mailing Address - Country:US
Mailing Address - Phone:626-431-2710
Mailing Address - Fax:626-229-7566
Practice Address - Street 1:50 BELLEFONTAINE ST STE 409
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3132
Practice Address - Country:US
Practice Address - Phone:626-431-2710
Practice Address - Fax:626-229-7566
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG079508174400000X
CAG07508208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G795080Medicaid
CAG63758Medicare UPIN
CAG79508Medicare ID - Type Unspecified