Provider Demographics
NPI:1487218723
Name:LODHIA, ALICIA KAROLINA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:KAROLINA
Last Name:LODHIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:KAROLINA
Other - Last Name:LUNDGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:260 SAN RAMON WAY
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-1132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 ROUTE 4 STE 207
Practice Address - Street 2:
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-4304
Practice Address - Country:US
Practice Address - Phone:671-477-2873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPA56879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program