Provider Demographics
NPI:1427225358
Name:KADISHA, ALEXANDRA (N/A)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:KADISHA
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4944 CASS ST UNIT 909
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2073
Mailing Address - Country:US
Mailing Address - Phone:619-985-5323
Mailing Address - Fax:
Practice Address - Street 1:2821 OCEANSIDE BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4800
Practice Address - Country:US
Practice Address - Phone:760-721-2781
Practice Address - Fax:760-721-9571
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564IMF56454101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health