Healthcare Provider Details

I. General information

NPI: 1760487458
Provider Name (Legal Business Name): JADWIGA M ALEXIEWICZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST ST STE 220
SAN DIEGO CA
92123-2771
US

IV. Provider business mailing address

9610 GRANITE RIDGE DR STE B
SAN DIEGO CA
92123-2684
US

V. Phone/Fax

Practice location:
  • Phone: 858-637-4700
  • Fax: 858-637-4701
Mailing address:
  • Phone: 858-810-8000
  • Fax: 858-268-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA64466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: