Provider Demographics
NPI:1639711450
Name:MENDOZA, ALEXANDRA ROUELLE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:ROUELLE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:ROUELLE
Other - Middle Name:PARAYNO
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5128 EDERIA WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313
Mailing Address - Country:US
Mailing Address - Phone:661-865-9963
Mailing Address - Fax:
Practice Address - Street 1:3941 SAN DIMAS ST STE 101
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5711
Practice Address - Country:US
Practice Address - Phone:661-864-7944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily