Provider Demographics
NPI:1487537411
Name:PETRASEK, ALEXANDRA (MS, CGC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:PETRASEK
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 HOLLOWAY DR APT 401
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2473
Mailing Address - Country:US
Mailing Address - Phone:818-371-6809
Mailing Address - Fax:
Practice Address - Street 1:444 S SAN VICENTE BLVD STE 1001
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4170
Practice Address - Country:US
Practice Address - Phone:310-423-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001270170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS