Provider Demographics
NPI:1598511081
Name:LEBEDEFF, ALEXANDRA MICHAEL
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MICHAEL
Last Name:LEBEDEFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:MICHAEL
Other - Last Name:LIND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8549 WILSHIRE BLVD # 163
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3104
Mailing Address - Country:US
Mailing Address - Phone:213-435-5000
Mailing Address - Fax:
Practice Address - Street 1:1748 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-2134
Practice Address - Country:US
Practice Address - Phone:213-435-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45510225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist