Provider Demographics
NPI:1598977647
Name:ALEXANDER, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2720
Mailing Address - Country:US
Mailing Address - Phone:562-733-1147
Mailing Address - Fax:562-733-1157
Practice Address - Street 1:17542 17TH ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1959
Practice Address - Country:US
Practice Address - Phone:949-214-9822
Practice Address - Fax:949-214-9822
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74900104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8166923OtherADLETA