Provider Demographics
NPI:1679011308
Name:LOVE, ALEXANDRA PAUL POLESHAJ
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:PAUL POLESHAJ
Last Name:LOVE
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 1:207 CONCORDIA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-1758
Mailing Address - Country:US
Mailing Address - Phone:808-277-1682
Mailing Address - Fax:
Practice Address - Street 1:207 CONCORDIA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-1758
Practice Address - Country:US
Practice Address - Phone:808-277-1682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI501106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist