Provider Demographics
NPI:1114514122
Name:LOW, ALEXANDRA ROSE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:ROSE
Last Name:LOW
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:MISS
Other - First Name:ALEXANDRA
Other - Middle Name:ROSE
Other - Last Name:GRUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC
Mailing Address - Street 1:1273 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3231
Mailing Address - Country:US
Mailing Address - Phone:408-838-1203
Mailing Address - Fax:
Practice Address - Street 1:1273 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3231
Practice Address - Country:US
Practice Address - Phone:408-838-1203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-302511174N00000X
390200000X
CA95270872163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, InpatientGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program