Provider Demographics
NPI:1669162921
Name:BASS, ALEXANDRA KIMBERLY
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KIMBERLY
Last Name:BASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27616 COBBLESTONE CT
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1863
Mailing Address - Country:US
Mailing Address - Phone:310-999-5901
Mailing Address - Fax:
Practice Address - Street 1:27616 COBBLESTONE CT
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-1863
Practice Address - Country:US
Practice Address - Phone:310-999-5901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23344225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist