Provider Demographics
NPI:1790016376
Name:ALEXANDRA PELLICENA MD PA
Entity Type:Organization
Organization Name:ALEXANDRA PELLICENA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLICENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-370-7325
Mailing Address - Street 1:1919 NORTH LOOP W
Mailing Address - Street 2:SUITE 215
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1374
Mailing Address - Country:US
Mailing Address - Phone:713-370-7325
Mailing Address - Fax:713-574-4683
Practice Address - Street 1:1919 NORTH LOOP W
Practice Address - Street 2:SUITE 215
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1374
Practice Address - Country:US
Practice Address - Phone:713-370-7325
Practice Address - Fax:713-574-4683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210320201Medicaid
0A5874Medicare Oscar/Certification