Provider Demographics
NPI:1215445234
Name:ROUTH, CHRISTINE ALESI (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ALESI
Last Name:ROUTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:A
Other - Last Name:LENIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 WHIPPLE AVE STE 140
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2844
Practice Address - Country:US
Practice Address - Phone:650-261-2366
Practice Address - Fax:650-261-2369
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA66558363AS0400X
AZ6969363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1146610OtherNCCPA BOARD CERTIFICATION
AZ459138Medicaid
AZ6969OtherAZ REGULATORY BOARD OF PHYSICIAN ASSISTANTS