Healthcare Provider Details

I. General information

NPI: 1255745048
Provider Name (Legal Business Name): ALCIDIA HOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5523 34TH ST
SACRAMENTO CA
95820-4725
US

IV. Provider business mailing address

2150 STOCKTON BLVD
SACRAMENTO CA
95817-1337
US

V. Phone/Fax

Practice location:
  • Phone: 916-452-3601
  • Fax: 916-453-2829
Mailing address:
  • Phone: 916-875-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number119492
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number80223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: