Provider Demographics
NPI:1467985143
Name:RUKSTELO, ALEXANDRA MONICA (DO)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MONICA
Last Name:RUKSTELO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:MONICA
Other - Last Name:OSTROMECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3010 BEARD RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3442
Mailing Address - Country:US
Mailing Address - Phone:707-255-8825
Mailing Address - Fax:707-252-9325
Practice Address - Street 1:3421 VILLA LN STE 2B
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3060
Practice Address - Country:US
Practice Address - Phone:072-555-4547
Practice Address - Fax:707-255-5411
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101024481208100000X
CA20A20612208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation