Healthcare Provider Details

I. General information

NPI: 1821278953
Provider Name (Legal Business Name): JESSICA SANCHEZ-ALFARO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA VADNAIS

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date: 07/01/2016
Reactivation Date: 07/20/2016

III. Provider practice location address

3931 LOUISIANA AVE S
SAINT LOUIS PARK MN
55426-5000
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3180
  • Fax:
Mailing address:
  • Phone:
  • 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 StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52051
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: