Provider Demographics
NPI:1568914018
Name:PRIEGO, ALEXSANDRA OLIVIA (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXSANDRA
Middle Name:OLIVIA
Last Name:PRIEGO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALEXSANDRA
Other - Middle Name:OLIVIA
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-933-1390
Practice Address - Street 1:1814 VILLAGE OAK CT
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5171
Practice Address - Country:US
Practice Address - Phone:512-580-9204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10828363A00000X
MDC0006829363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant