MEDICARE: ALEXANDRA DE LA PENA

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	207P00000X	Emergency Medicine Physician	0110-008529	VA
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1548919814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA DE LA PENA

Provider Business Mailing Address
First Line	:	2401 GROVE AVE APT B
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4567
Country	:	US
Telephone Number	:	919-606-0036
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 GROVE AVE APT B
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4567
Country	:	US
Telephone Number	:	919-606-0036
Fax Number	:

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

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	06/22/2022

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Directions to “ ALEXANDRA DE LA PENA ” Practice Location

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