Provider Demographics
NPI:1588734974
Name:CHRYSANTHIS, ALEXANDRA A (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:A
Last Name:CHRYSANTHIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10861 CHERRY ST
Mailing Address - Street 2:200
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5402
Mailing Address - Country:US
Mailing Address - Phone:562-795-6406
Mailing Address - Fax:562-795-6409
Practice Address - Street 1:10861 CHERRY ST
Practice Address - Street 2:200
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5402
Practice Address - Country:US
Practice Address - Phone:562-795-6406
Practice Address - Fax:562-795-6409
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G80464Medicare UPIN