Healthcare Provider Details

I. General information

NPI: 1629544556
Provider Name (Legal Business Name): KATY ALEXY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 LONE TREE WAY
ANTIOCH CA
94509-6200
US

IV. Provider business mailing address

4356 OAKDALE PL
PITTSBURG CA
94565-6256
US

V. Phone/Fax

Practice location:
  • Phone: 925-779-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number56211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: