Provider Demographics
NPI:1194542910
Name:FOGLE, ALEXIA BREE
Entity type:Individual
Prefix:
First Name:ALEXIA
Middle Name:BREE
Last Name:FOGLE
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 1:1752 E LUGONIA AVE STE 117-1094
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2730
Mailing Address - Country:US
Mailing Address - Phone:909-654-6798
Mailing Address - Fax:
Practice Address - Street 1:1752 E LUGONIA AVE STE 117-1094
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2730
Practice Address - Country:US
Practice Address - Phone:909-654-6798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician