Provider Demographics
NPI:1356851869
Name:HOM, ALEXANDRA KANE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KANE
Last Name:HOM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MOUNTAIRE PL
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-1524
Mailing Address - Country:US
Mailing Address - Phone:925-852-4499
Mailing Address - Fax:
Practice Address - Street 1:41 MOUNTAIRE PL
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:CA
Practice Address - Zip Code:94517-1524
Practice Address - Country:US
Practice Address - Phone:925-852-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant