Provider Demographics
NPI:1316656531
Name:GEONETTA, ALEXANDRA (CLES)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GEONETTA
Suffix:
Gender:F
Credentials:CLES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5265 VIA SAN DELARRO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-2112
Mailing Address - Country:US
Mailing Address - Phone:925-324-4361
Mailing Address - Fax:
Practice Address - Street 1:5265 VIA SAN DELARRO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2112
Practice Address - Country:US
Practice Address - Phone:925-324-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174N00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN