Provider Demographics
NPI:1578963492
Name:ALESANDRO, ALYCE FAYE (RT (R) CT M -OB/GYN)
Entity Type:Individual
Prefix:
First Name:ALYCE
Middle Name:FAYE
Last Name:ALESANDRO
Suffix:
Gender:F
Credentials:RT (R) CT M -OB/GYN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11784 VONNIE CLAIRE RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-8530
Mailing Address - Country:US
Mailing Address - Phone:303-642-0682
Mailing Address - Fax:
Practice Address - Street 1:11784 VONNIE CLAIRE RD
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-8530
Practice Address - Country:US
Practice Address - Phone:303-642-0682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO385057247100000X, 2471C3401X, 2471M2300X
CO1515042471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography