Most Relevant Information
Provider Data
| NPI Number: | 1003694050 |
| Provider Name: | ALEXANDRA TARA GARDNER |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/20/2023 |
| Last Updated: | 09/20/2023 |
Provider Practice Location
16573 OLD AUBURN RD
GRASS VALLEY
CA
95949
Practice Location Phone/Fax
| Phone: | 5302730631 |
| Fax: | 9165044328 |
Provider Mailing Location
16573 OLD AUBURN RD
GRASS VALLEY
CA
95949
Provider Mailing Phone/Fax
| Phone: | 5302730631 |
| Fax: | 9165044328 |