Healthcare Provider Details

I. General information

NPI: 1992631584
Provider Name (Legal Business Name): ALEXIS JADE DANIELS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TWIN RIVERS SCHOOL DISTRICT 5115 DUDLEY BOULEVARD
MCCLELLAN PARK CA
95652
US

IV. Provider business mailing address

6609 TRONZANO WAY
ELK GROVE CA
95757-3057
US

V. Phone/Fax

Practice location:
  • Phone: 916-566-1600
  • Fax:
Mailing address:
  • Phone: 916-996-8907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: