MEDICARE: ALEXANDRA MARIE RAWLS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP95029642	CA

General Provider Information

NPI Number	:	1629806062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA MARIE RAWLS FNP-C

Provider Business Mailing Address
First Line	:	3338 NILE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-4816
Country	:	US
Telephone Number	:	619-701-0466
Fax Number	:

Provider Business Practice Location Address
First Line	:	3338 NILE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-4816
Country	:	US
Telephone Number	:	619-701-0466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2024
Last Update Date	:	07/25/2024

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