MEDICARE: DR. ALEXANDRA PELLICENA MD

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	207V00000X	Obstetrics & Gynecology Physician	K7862	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578564886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDRA PELLICENA MD

Provider Business Mailing Address
First Line	:	1919 NORTH LOOP W
Second Line	:	SUITE 215
City	:	HOUSTON
State	:	TX
Zip	:	77008-1374
Country	:	US
Telephone Number	:	713-370-7325
Fax Number	:	713-574-4683

Provider Business Practice Location Address
First Line	:	1919 NORTH LOOP W
Second Line	:	SUITE 215
City	:	HOUSTON
State	:	TX
Zip	:	77008-1374
Country	:	US
Telephone Number	:	713-370-7325
Fax Number	:	713-574-4683

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	06/09/2022

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