| NPI | 1518412345 |
|---|---|
| Former Name | ALEXA DIAMOND BOUBALOS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95009707) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: CA 95104937) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2020-09-16 |