Provider Demographics
NPI:1154906055
Name:ARCHANGEL, ALEXANDRIA K
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:K
Last Name:ARCHANGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8905 DAVIS RD APT I58
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1880
Mailing Address - Country:US
Mailing Address - Phone:209-412-2388
Mailing Address - Fax:
Practice Address - Street 1:1111 W TOKAY ST STE A
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3965
Practice Address - Country:US
Practice Address - Phone:120-941-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator