Provider Demographics
NPI:1922301522
Name:MCSPADDEN, ALEXANDRA MAYA (PA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MAYA
Last Name:MCSPADDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 MENDOCINO AVENUE SUITE 130
Mailing Address - Street 2:KAISER PERMANENTE COSMETIC SERVICES
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403
Mailing Address - Country:US
Mailing Address - Phone:707-566-5288
Mailing Address - Fax:
Practice Address - Street 1:3333 MENDOCINO AVENUE SUITE 130
Practice Address - Street 2:KAISER PERMANENTE COSMETIC SERVICES
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-566-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0840363AM0700X, 363AS0400X
CAPA22312363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical