Provider Demographics
NPI:1093542383
Name:MITROVICH, ALEXANDRA (ND)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MITROVICH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 REIMAN LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9677
Mailing Address - Country:US
Mailing Address - Phone:707-484-4310
Mailing Address - Fax:
Practice Address - Street 1:1160 N DUTTON AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4600
Practice Address - Country:US
Practice Address - Phone:707-888-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath