Provider Demographics
NPI:1568633915
Name:ROCCO, ALEXANDRA S (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:S
Last Name:ROCCO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150087
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415-0087
Mailing Address - Country:US
Mailing Address - Phone:801-917-8000
Mailing Address - Fax:801-917-8001
Practice Address - Street 1:5782 ADAMS AVENUE PARKWAY
Practice Address - Street 2:
Practice Address - City:WASHINGTON TERRACE
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-917-8000
Practice Address - Fax:801-917-8001
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6830069-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP97686Medicare UPIN