Provider Demographics
NPI:1275007742
Name:PECK, ALEXANDRA (NP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ALEX MALLIARIS
Mailing Address - Street 1:1450 TREAT BLVD # 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:
Practice Address - Street 1:1220 ROSSMOOR PKWY
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-2501
Practice Address - Country:US
Practice Address - Phone:925-939-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily