Healthcare Provider Details

I. General information

NPI: 1376255158
Provider Name (Legal Business Name): ALEXANDRA KATE POLLACK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2022
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8190 E 1ST AVE STE 100
DENVER CO
80230-7211
US

IV. Provider business mailing address

7351 E LOWRY BLVD STE 200
DENVER CO
80230-6083
US

V. Phone/Fax

Practice location:
  • Phone: 877-825-8584
  • Fax:
Mailing address:
  • Phone: 877-825-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007718
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: