Healthcare Provider Details

I. General information

NPI: 1891769105
Provider Name (Legal Business Name): ALEXANDER HAZEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 AUBURN BLVD
SACRAMENTO CA
95841-4100
US

IV. Provider business mailing address

PO BOX 4217
DAVIS CA
95617-4217
US

V. Phone/Fax

Practice location:
  • Phone: 530-400-5607
  • Fax:
Mailing address:
  • Phone: 530-400-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20A8379
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A8379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: