Provider Demographics
NPI:1679795488
Name:ALEXANDER, SHIRLEY J (MA)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:J
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1001
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-1001
Mailing Address - Country:US
Mailing Address - Phone:323-226-5073
Mailing Address - Fax:323-226-4417
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:OPD 2P70
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1029
Practice Address - Country:US
Practice Address - Phone:323-226-5073
Practice Address - Fax:323-226-4417
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 1046231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist