Provider Demographics
NPI:1487081543
Name:ALEXANDER, MAUREEN (LAC CMT MTOM)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LAC CMT MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12667 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1535
Mailing Address - Country:US
Mailing Address - Phone:570-337-0712
Mailing Address - Fax:
Practice Address - Street 1:12667 DEWEY ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-1535
Practice Address - Country:US
Practice Address - Phone:570-337-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15309171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist