Healthcare Provider Details

I. General information

NPI: 1902268253
Provider Name (Legal Business Name): ALEXANDRA MOORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

26 FLAGSTONE CT
ALAMO CA
94507-1601
US

V. Phone/Fax

Practice location:
  • Phone: 925-708-8981
  • Fax:
Mailing address:
  • Phone: 925-708-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberU3949
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberU3949
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA153908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: