Provider Demographics
NPI:1528599875
Name:BEDOLLA, ALEJANDRA JAIMES
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:JAIMES
Last Name:BEDOLLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEJANDRA
Other - Middle Name:
Other - Last Name:BEDOLLA JAIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-0081
Mailing Address - Country:US
Mailing Address - Phone:559-899-4588
Mailing Address - Fax:
Practice Address - Street 1:710 K ST APT B
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2665
Practice Address - Country:US
Practice Address - Phone:559-899-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT00012416246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy