Individual
ALEX CHADWICK VAN DER HAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
26730 TOWNE CENTRE DR STE 204, LAKE FOREST, CA 92610-2842
(949) 380-1234
Mailing address
26730 TOWNE CENTRE DR STE 204, FOOTHILL RANCH, CA 92610-2842
(714) 589-5123
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
59204
CA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
10/21/2019
Last updated
04/08/2021
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