Provider Demographics
NPI:1174506828
Name:ALEXANDER, KENNETH CHARLES (PA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CHARLES
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:13193 CENTRAL AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710
Mailing Address - Country:US
Mailing Address - Phone:909-902-9111
Mailing Address - Fax:909-902-9199
Practice Address - Street 1:13193 CENTRAL AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-902-9111
Practice Address - Fax:909-902-9199
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA10648363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical