Provider Demographics
NPI:1730286832
Name:MEAD, ALEXANDRA MOATS (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MOATS
Last Name:MEAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:LOUISE
Other - Last Name:MOATS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2855 MITCHELL DR #223
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1609
Mailing Address - Country:US
Mailing Address - Phone:510-452-1345
Mailing Address - Fax:510-452-1102
Practice Address - Street 1:365 HAWTHORNE AVE STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3114
Practice Address - Country:US
Practice Address - Phone:510-452-1345
Practice Address - Fax:510-452-1102
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA15000OtherPA LICENSE NUMBER