Basic Information
| Provider Information | |||||||||
| NPI: | 1033407275 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | ALEXANDER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2124 S EL CAMINO REAL STE 100 | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920546211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607297101 | ||||||||
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| Practice Location | |||||||||
| Address1: | 477 N EL CAMINO REAL STE C202 | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606313500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2011 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0120X | A124880 | CA | Y | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 1033407275 | 05 | WA | MEDICAID | 8966230 | 01 | WA | MEDICARE PIN | OTHER |