Provider Demographics
NPI:1295968204
Name:MCPHETERS, ALEXANDER (BS)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:MCPHETERS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:ALEC
Other - Middle Name:
Other - Last Name:MCPHETERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:11921 GOSHEN AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6324
Mailing Address - Country:US
Mailing Address - Phone:917-518-5586
Mailing Address - Fax:
Practice Address - Street 1:4199 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-4684
Practice Address - Country:US
Practice Address - Phone:949-737-5460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program