Healthcare Provider Details

I. General information

NPI: 1346873536
Provider Name (Legal Business Name): ALEXANDRA ANDERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1861 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-7868
US

IV. Provider business mailing address

21600 OXNARD ST STE 1800
WOODLAND HILLS CA
91367-7807
US

V. Phone/Fax

Practice location:
  • Phone: 866-628-7828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0008594
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: