Healthcare Provider Details

I. General information

NPI: 1710893029
Provider Name (Legal Business Name): ALEX ULYSSES FEDERICO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 DWIGHT RD
ELK GROVE CA
95758-6456
US

IV. Provider business mailing address

3161 DWIGHT RD
ELK GROVE CA
95758-6456
US

V. Phone/Fax

Practice location:
  • Phone: 916-427-7141
  • Fax: 916-427-7122
Mailing address:
  • Phone: 916-427-7141
  • Fax: 916-427-7122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: