Basic Information
| Provider Information | |||||||||
| NPI: | 1568832657 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALEXIS DOUGHERTY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 E ARRELLAGA ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931032275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323419832 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 E ARRELLAGA ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931032275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056875538 | ||||||||
| FaxNumber: | 8056875530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2015 | ||||||||
| LastUpdateDate: | 08/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | DOUGHERTY | ||||||||
| AuthorizedOfficialFirstName: | ALEXIS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8323419832 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 08/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | A126933 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.