Individual
ALEXIS LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1625 SCHRADER BLVD, LOS ANGELES, CA 90028-6213
(323) 860-7304
Mailing address
1625 SCHRADER BLVD, LOS ANGELES, CA 90028-6213
(323) 860-7304
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01536011
—
CA
Enumeration date
01/24/2025
Last updated
01/24/2025
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