Healthcare Provider Details

I. General information

NPI: 1114514122
Provider Name (Legal Business Name): ALEXANDRA ROSE LOW CNM, WHNP, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRA ROSE GRUBER IBCLC

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 CHANTICLEER AVE
SANTA CRUZ CA
95065-1815
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 831-477-2375
  • Fax: 831-477-2380
Mailing address:
  • Phone: 866-681-0738
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-302511
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number95270872
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW236502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: