Healthcare Provider Details

I. General information

NPI: 1023886629
Provider Name (Legal Business Name): ALEXUS M MIZERAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ETHAN WAY STE 200
SACRAMENTO CA
95825-2277
US

IV. Provider business mailing address

6020 TELESCO WAY
CARMICHAEL CA
95608-0817
US

V. Phone/Fax

Practice location:
  • Phone: 916-800-2872
  • Fax:
Mailing address:
  • Phone: 916-505-5203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: