=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346113594
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEJANDRA GRAJEDA RUIZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2025
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 268 LEWELLING BLVD
-----------------------------------------------------
City | SAN LORENZO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-628-0851
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2016 27TH AVE
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94601-1830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-362-5741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164X00000X
-----------------------------------------------------
Taxonomy Name | Licensed Vocational Nurse
-----------------------------------------------------
License Number | 742503
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------