Healthcare Provider Details

I. General information

NPI: 1205107216
Provider Name (Legal Business Name): ALEXANDRA ALLYNE BLAUFARB NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SAN PABLO AVE STE 300
ALBANY CA
94706-1103
US

IV. Provider business mailing address

2350 W EL CAMINO REAL FL 2
MOUNTAIN VIEW CA
94040-6203
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8130
  • Fax: 510-524-0861
Mailing address:
  • Phone: 707-541-7700
  • Fax: 707-573-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number765494
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: