Healthcare Provider Details

I. General information

NPI: 1811644701
Provider Name (Legal Business Name): ALEX N/A VUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3336 BRADSHAW ROAD SUITE 140
SACRAMENTO CA
95827
US

IV. Provider business mailing address

3336 BRADSHAW ROAD SUITE 140
SACRAMENTO CA
95827
US

V. Phone/Fax

Practice location:
  • Phone: 916-632-1330
  • Fax:
Mailing address:
  • Phone: 916-632-1330
  • Fax: 855-568-2494

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: