Healthcare Provider Details

I. General information

NPI: 1790835809
Provider Name (Legal Business Name): ALEXZANDRA KATHRYN HOLLINGWORTH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST SUITE 3015
PHOENIX AZ
85020-2437
US

IV. Provider business mailing address

9250 N 3RD ST SUITE 3015
PHOENIX AZ
85020-2437
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-3722
  • Fax: 602-953-5466
Mailing address:
  • Phone: 602-633-3722
  • Fax: 602-953-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number42595
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number42595
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: