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NPI Code Detail

MEDICARE: ALEXANDRA MOATS MEAD PA-C

MEDICARE: ALEXANDRA MOATS MEAD PA-C
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 AssistantPA15000CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA15000OTHERCAPA LICENSE NUMBER

General Provider Information

NPI Number : 1730286832
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA MOATS MEAD PA-C
Provider Business Mailing Address
First Line : 2855 MITCHELL DR #223
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94598-1609
Country : US
Telephone Number : 510-452-1345
Fax Number : 510-452-1102
Provider Business Practice Location Address
First Line : 365 HAWTHORNE AVE STE 201
Second Line :
City : OAKLAND
State : CA
Zip : 94609-3114
Country : US
Telephone Number : 510-452-1345
Fax Number : 510-452-1102
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/01/2010

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Directions to “ ALEXANDRA MOATS MEAD PA-C” Practice Location

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