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General NPI Number Information
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NPI Number | 1710726948
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Entity Type | Individual
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Provider Name | ALEXANDRA DEROSA PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 160 E ARTESIA ST STE 325
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City | POMONA
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State | CA
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Zip | 91767-2922
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Country | US
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Telephone | 909-620-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 441 STUART ST STE 404
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City | BOSTON
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State | MA
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Zip | 02116-5019
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Country | US
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Telephone | 857-317-2057
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Fax | 857-317-2811
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA102136
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License Number State | MA
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