Provider Demographics
NPI:1124910914
Name:MATEVOSIAN, ALEXANDRA MARIA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARIA
Last Name:MATEVOSIAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:MARIA
Other - Last Name:LIPOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:13090 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-9013
Mailing Address - Country:US
Mailing Address - Phone:323-898-5414
Mailing Address - Fax:
Practice Address - Street 1:13090 3RD AVE
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-9013
Practice Address - Country:US
Practice Address - Phone:323-898-5414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist