MEDICARE: ALEXANDER RHODES FACQUE

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
1	2086S0122X	Plastic and Reconstructive Surgery Physician	A161637	CA

General Provider Information

NPI Number	:	1336415801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER RHODES FACQUE

Provider Business Mailing Address
First Line	:	450 SUTTER ST RM 1000
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-3913
Country	:	US
Telephone Number	:	415-398-7778
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 SUTTER ST RM 1000
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-3913
Country	:	US
Telephone Number	:	415-398-7778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2012
Last Update Date	:	09/20/2021

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