Basic Information
| Provider Information | |||||||||
| NPI: | 1457918732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | HERMAN | ||||||||
| MiddleName: | O. | ||||||||
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| Credential: | CADTP 5390-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941031589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158633883 | ||||||||
| FaxNumber: | 4158637343 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941031509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158633883 | ||||||||
| FaxNumber: | 4158637343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2019 | ||||||||
| LastUpdateDate: | 07/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 5390-R | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 5390-R | 05 | CA | MEDICAID |