Healthcare Provider Details

I. General information

NPI: 1013343789
Provider Name (Legal Business Name): ALEXIS MARIE ARAGON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BROADWAY
SACRAMENTO CA
95820-1527
US

IV. Provider business mailing address

4600 BROADWAY
SACRAMENTO CA
95820-1527
US

V. Phone/Fax

Practice location:
  • Phone: 650-996-6718
  • Fax:
Mailing address:
  • Phone:
  • Fax: 510-865-1930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: