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NPI Code Detail

MEDICARE: ALEXIS ROSE VAVALA

MEDICARE: ALEXIS ROSE VAVALA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1003416165
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS ROSE VAVALA
Provider Business Mailing Address
First Line : 1885 MARKET ST
Second Line :
City : WARREN
State : PA
Zip : 16365-1277
Country : US
Telephone Number : 814-723-1832
Fax Number :
Provider Business Practice Location Address
First Line : 1885 MARKET ST
Second Line :
City : WARREN
State : PA
Zip : 16365-1277
Country : US
Telephone Number : 814-723-1832
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2020
Last Update Date : 10/24/2022

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Directions to “ ALEXIS ROSE VAVALA ” Practice Location

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