Provider Demographics
NPI:1396073144
Name:NEOFITIDIS, ALEXANDER
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:NEOFITIDIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10765 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-8103
Mailing Address - Country:US
Mailing Address - Phone:858-410-1067
Mailing Address - Fax:619-533-6007
Practice Address - Street 1:10765 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-8103
Practice Address - Country:US
Practice Address - Phone:858-410-1067
Practice Address - Fax:619-533-6007
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator