Provider Demographics
NPI:1487218723
Name:LODHIA, ALICIA KAROLINA (PA-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:KAROLINA
Last Name:LODHIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:KAROLINA
Other - Last Name:LUNDGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:U.S. NAVAL HOSPITAL GUAM
Mailing Address - Street 2:PSC 455 BOX 208
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:U.S. NAVAL HOSPITAL GUAM
Practice Address - Street 2:BLDG 50, FARENHOLT AVE
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-344-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPA56879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program