Provider Demographics
NPI:1093530354
Name:RAHWANJI, ALEXIS MIMI DEDE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:MIMI DEDE
Last Name:RAHWANJI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22810 CARDINAL ST
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5760
Mailing Address - Country:US
Mailing Address - Phone:510-734-0731
Mailing Address - Fax:
Practice Address - Street 1:9415 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-2661
Practice Address - Country:US
Practice Address - Phone:833-865-8263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95032884363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care