Provider Demographics
NPI:1427285949
Name:BAXTER, ROXANA REYNAFARJE (MSPA-C)
Entity type:Individual
Prefix:MRS
First Name:ROXANA
Middle Name:REYNAFARJE
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MSPA-C
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:23823 EL TORO RD STE E122
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4743
Mailing Address - Country:US
Mailing Address - Phone:949-380-1227
Mailing Address - Fax:949-380-1759
Practice Address - Street 1:23823 EL TORO RD STE E122
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4743
Practice Address - Country:US
Practice Address - Phone:949-380-1227
Practice Address - Fax:949-380-1759
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA16702363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical