Provider Demographics
NPI:1932425956
Name:JOHNSON, ALEXANDRA ROTHENBERG (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:ROTHENBERG
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 GLEN CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1219
Mailing Address - Country:US
Mailing Address - Phone:510-455-8008
Mailing Address - Fax:510-244-0569
Practice Address - Street 1:1690 GLEN CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1219
Practice Address - Country:US
Practice Address - Phone:510-455-8008
Practice Address - Fax:510-244-0569
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA148633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO316228YL0XOtherMEDICARE NUMBER