MEDICARE: DR. JADWIGA M ALEXIEWICZ 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	207RN0300X	Nephrology Physician	A64466	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WA64466A	OTHER	CA	SO. CALIFORNIA PTAN

General Provider Information

NPI Number	:	1760487458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JADWIGA M ALEXIEWICZ MD

Provider Business Mailing Address
First Line	:	9610 GRANITE RIDGE DR
Second Line	:	STE B
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2684
Country	:	US
Telephone Number	:	858-810-8000
Fax Number	:	858-268-1911

Provider Business Practice Location Address
First Line	:	7910 FROST ST
Second Line	:	STE 220
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2771
Country	:	US
Telephone Number	:	858-637-4700
Fax Number	:	858-637-4701

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	09/18/2015

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