Basic Information
| Provider Information | |||||||||
| NPI: | 1093112658 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAME | ||||||||
| FirstName: | ALEXANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1625 SCHRADER BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900286213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239932925 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23501 CINEMA DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913555430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612884800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2014 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1041C0700X | 100763 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 01536011 | 01 | CA | MEDI-CAL | OTHER |