Provider Demographics
NPI:1871077107
Name:FASSI, ALEXANDRA LYNNE
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LYNNE
Last Name:FASSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 KATELLA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6829
Mailing Address - Country:US
Mailing Address - Phone:714-490-3428
Mailing Address - Fax:
Practice Address - Street 1:27758 SANTA MARGARITA PKWY # 263
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6709
Practice Address - Country:US
Practice Address - Phone:619-933-4710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120358106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist