Provider Demographics
NPI:1154167229
Name:AXELRODE PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:AXELRODE PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAVATTUVEETIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-936-8137
Mailing Address - Street 1:3075 BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 APPIAN WAY STE 301
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2525
Practice Address - Country:US
Practice Address - Phone:510-724-8855
Practice Address - Fax:510-724-8861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty