Healthcare Provider Details

I. General information

NPI: 1992254551
Provider Name (Legal Business Name): ALEXIS RICCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 S ARIZONA AVE APT 1081
CHANDLER AZ
85286-7725
US

IV. Provider business mailing address

2150 S ARIZONA AVE APT 1081
CHANDLER AZ
85286-7725
US

V. Phone/Fax

Practice location:
  • Phone: 602-435-9237
  • Fax: 602-896-2580
Mailing address:
  • Phone: 602-435-9237
  • Fax: 602-896-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number7709498
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: