Provider Demographics
NPI:1114550597
Name:ALEJANDRO, IRENE (DC)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:ALEJANDRO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 SAN RAMON VALLEY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1597
Mailing Address - Country:US
Mailing Address - Phone:925-587-8276
Mailing Address - Fax:
Practice Address - Street 1:2355 SAN RAMON VALLEY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1597
Practice Address - Country:US
Practice Address - Phone:925-587-8276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor