Provider Demographics
NPI:1811429418
Name:KELADA, ALEXANDRAMARY (DO, MPH)
Entity type:Individual
Prefix:
First Name:ALEXANDRAMARY
Middle Name:
Last Name:KELADA
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4110
Mailing Address - Country:US
Mailing Address - Phone:916-786-4700
Mailing Address - Fax:916-786-3912
Practice Address - Street 1:680 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4110
Practice Address - Country:US
Practice Address - Phone:916-786-4700
Practice Address - Fax:916-786-3912
Is Sole Proprietor?:No
Enumeration Date:2017-04-02
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine