Healthcare Provider Details

I. General information

NPI: 1295092203
Provider Name (Legal Business Name): ALEXIS NICOLE JANNICELLI TONEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 STOCKTON BLVD TICON 2, SUITE 340
SACRAMENTO CA
95817-2208
US

IV. Provider business mailing address

2390 ROUALT ST
DAVIS CA
95618-7653
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5387
  • Fax:
Mailing address:
  • Phone: 707-315-7593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA126594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: