Basic Information
| Provider Information | |||||||||
| NPI: | 1558519280 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAURA D ALEXANDER MD A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17530 VENTURA BLVD STE 201 | ||||||||
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| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913163889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185014421 | ||||||||
| FaxNumber: | 8187896626 | ||||||||
| Practice Location | |||||||||
| Address1: | 1328 22ND ST | ||||||||
| Address2: | DEPARTMENT OF ANESTHESIOLOGY | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108298202 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2008 | ||||||||
| LastUpdateDate: | 03/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | ALEXANDER | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | DIANE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3104351202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A77654 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.