Provider Demographics
NPI:1548501703
Name:ALEXANDER, JON ERIC (CADCA)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:ERIC
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:CADCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 CAMPANILE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92182-0001
Mailing Address - Country:US
Mailing Address - Phone:858-467-6810
Mailing Address - Fax:
Practice Address - Street 1:5500 CAMPANILE DR.
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92182
Practice Address - Country:US
Practice Address - Phone:858-467-6810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13240214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13240214OtherCAADAC