Provider Demographics
NPI:1629590971
Name:GROSSMAN MOON, ALEXANDRA (MD, MSW)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:GROSSMAN MOON
Suffix:
Gender:F
Credentials:MD, MSW
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:GROSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:9909 MIRA MESA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1061
Mailing Address - Country:US
Mailing Address - Phone:858-657-7750
Mailing Address - Fax:
Practice Address - Street 1:9909 MIRA MESA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1061
Practice Address - Country:US
Practice Address - Phone:858-657-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No104100000XBehavioral Health & Social Service ProvidersSocial Worker