Provider Demographics
NPI:1396497020
Name:ALEXIS, PAIGE MATTHEW
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:MATTHEW
Last Name:ALEXIS
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 1:14689 MOON CREST LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4367
Mailing Address - Country:US
Mailing Address - Phone:909-230-8730
Mailing Address - Fax:
Practice Address - Street 1:14516 PIPELINE AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5634
Practice Address - Country:US
Practice Address - Phone:909-485-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73782225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist