Healthcare Provider Details

I. General information

NPI: 1275785529
Provider Name (Legal Business Name): ALEXANDRA RAQUEL FOGLI MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 WARD STREET
BERKELEY CA
94703
US

IV. Provider business mailing address

1827 WARD ST
BERKELEY CA
94703-2127
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-6060
  • Fax:
Mailing address:
  • Phone: 415-833-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: