Provider Demographics
NPI:1659075059
Name:ROSS, ALEXANDRA KATHERINE
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KATHERINE
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEXIE
Other - Middle Name:KATHERINE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:430 BROADWAY ST., MC: 6342
Mailing Address - Street 2:PAVILION C, 4TH FLOOR
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-3132
Mailing Address - Country:US
Mailing Address - Phone:650-721-7669
Mailing Address - Fax:
Practice Address - Street 1:430 BROADWAY ST., MC: 6342
Practice Address - Street 2:PAVILION C, 4TH FLOOR
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-3132
Practice Address - Country:US
Practice Address - Phone:650-721-7669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program