Provider Demographics
NPI:1275681157
Name:PAGE, ALEXANDRA E (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:E
Last Name:PAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 ALVARADO RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5270
Mailing Address - Country:US
Mailing Address - Phone:619-229-3934
Mailing Address - Fax:619-582-2860
Practice Address - Street 1:6719 ALVARADO RD
Practice Address - Street 2:STE. 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5270
Practice Address - Country:US
Practice Address - Phone:619-229-3934
Practice Address - Fax:619-582-2860
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84448207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB257435Medicare PIN