Provider Demographics
NPI:1285807990
Name:SIPORIN, ALEXANDORA EKKENS
Entity type:Individual
Prefix:
First Name:ALEXANDORA
Middle Name:EKKENS
Last Name:SIPORIN
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 1:955 N DUESENBERG DR
Mailing Address - Street 2:#6322
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-7913
Mailing Address - Country:US
Mailing Address - Phone:505-934-0860
Mailing Address - Fax:
Practice Address - Street 1:955 N DUESENBERG DR
Practice Address - Street 2:#6322
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-7913
Practice Address - Country:US
Practice Address - Phone:505-934-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11828208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics