Provider Demographics
NPI:1639627730
Name:SCHROEDER, ALICIA MARIA (NP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIA
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MARIA
Other - Last Name:LEDESMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1145 E CLARK AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ORCUTT
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5151
Mailing Address - Country:US
Mailing Address - Phone:805-332-4626
Mailing Address - Fax:805-345-2175
Practice Address - Street 1:1145 E CLARK AVE STE C
Practice Address - Street 2:
Practice Address - City:ORCUTT
Practice Address - State:CA
Practice Address - Zip Code:93455-5151
Practice Address - Country:US
Practice Address - Phone:805-332-4626
Practice Address - Fax:805-345-2175
Is Sole Proprietor?:No
Enumeration Date:2016-09-17
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily