Healthcare Provider Details

I. General information

NPI: 1295054260
Provider Name (Legal Business Name): ALEXANDRA COLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MOWRY AVE
FREMONT CA
94538-1716
US

IV. Provider business mailing address

PO BOX 24365
SAN JOSE CA
95154-4365
US

V. Phone/Fax

Practice location:
  • Phone: 510-797-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA111792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: