Provider Demographics
NPI:1497128722
Name:SANROMA, ALEXANDRA BLUE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:BLUE
Last Name:SANROMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ALEXANDRA
Other - Middle Name:BLUE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:500 S UNIVERSITY AVE
Mailing Address - Street 2:LITTLE ROCK DERMATOLOGY CLINIC SUITE 301
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5302
Mailing Address - Country:US
Mailing Address - Phone:501-664-4161
Mailing Address - Fax:501-664-6108
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:LITTLE ROCK DERMATOLOGY CLINIC SUITE 301
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5302
Practice Address - Country:US
Practice Address - Phone:501-664-4161
Practice Address - Fax:501-664-6108
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP-T1551363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP-T1551OtherSTATE