Provider Demographics
NPI:1770360018
Name:PERDOMO, ALEJANDRA (RN)
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:PERDOMO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12821 N FOX HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-7911
Mailing Address - Country:US
Mailing Address - Phone:520-406-1911
Mailing Address - Fax:
Practice Address - Street 1:12821 N FOX HOLLOW DR
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-7911
Practice Address - Country:US
Practice Address - Phone:520-406-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN210796163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool