Provider Demographics
NPI:1912377805
Name:BAKOS, ALEXANDRA (MA, EDD, LED)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:BAKOS
Suffix:
Gender:F
Credentials:MA, EDD, LED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 CANDELERO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5649
Mailing Address - Country:US
Mailing Address - Phone:505-577-7511
Mailing Address - Fax:
Practice Address - Street 1:2155 CANDELERO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5649
Practice Address - Country:US
Practice Address - Phone:505-577-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM30010141246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other