Provider Demographics
NPI:1528360724
Name:DICARO, ALEJANDRA MARIA (PA)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:MARIA
Last Name:DICARO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0209
Mailing Address - Country:US
Mailing Address - Phone:912-427-7400
Mailing Address - Fax:912-385-2953
Practice Address - Street 1:1140 W LA VETA AVE STE 700
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4229
Practice Address - Country:US
Practice Address - Phone:714-547-5404
Practice Address - Fax:714-547-0935
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007847363A00000X
CA21258363A00000X
CAPA21258363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEZ152ZMedicare PIN