Basic Information
Provider Information
NPI: 1033558846
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: ALEXANDRA
MiddleName: SARA
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3467 W SHAW AVE STE 101
Address2:  
City: FRESNO
State: CA
PostalCode: 937113223
CountryCode: US
TelephoneNumber: 5592713096
FaxNumber: 5592740292
Practice Location
Address1: 3467 W SHAW AVE STE 101
Address2:  
City: FRESNO
State: CA
PostalCode: 937113223
CountryCode: US
TelephoneNumber: 5592713096
FaxNumber: 5592740292
Other Information
ProviderEnumerationDate: 06/14/2013
LastUpdateDate: 06/14/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X  Y Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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