Healthcare Provider Details

I. General information

NPI: 1134798028
Provider Name (Legal Business Name): ALEXANDER NGO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE
MODESTO CA
95350-4405
US

IV. Provider business mailing address

2848 ROYAL OAKS DR
EL DORADO HILLS CA
95762-8029
US

V. Phone/Fax

Practice location:
  • Phone: 559-696-0947
  • Fax:
Mailing address:
  • Phone: 559-696-0947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number141467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: