Provider Demographics
NPI:1063761500
Name:INGRAM, ALEXANDRA ALABATA (PA)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ALABATA
Last Name:INGRAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:ALABATA
Other - Last Name:SANBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:355 LENNON LN
Mailing Address - Street 2:SUITE 295
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-357-9786
Mailing Address - Fax:925-217-7956
Practice Address - Street 1:355 LENNON LN
Practice Address - Street 2:SUITE 295
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-357-9786
Practice Address - Fax:925-217-7956
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA1466363A00000X
ALPA.1466363A00000X
FLPA9106852363AM0700X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007248400Medicaid
FLP01115957OtherRAILROAD MEDICARE
FLP01115957OtherRAILROAD MEDICARE