Basic Information
| Provider Information | |||||||||
| NPI: | 1194168724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERCHANT | ||||||||
| FirstName: | ALEXA | ||||||||
| MiddleName: | JUDITH | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2720 S BRISTOL ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927046207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884999303 | ||||||||
| FaxNumber: | 7145572251 | ||||||||
| Practice Location | |||||||||
| Address1: | 2720 S BRISTOL ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927046207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884999303 | ||||||||
| FaxNumber: | 7145572251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2013 | ||||||||
| LastUpdateDate: | 02/25/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 740199 | CA | Y | Nursing Service Providers | Registered Nurse | 363LG0600X | 23657 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LA2200X | 23657 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.