Healthcare Provider Details

I. General information

NPI: 1013724673
Provider Name (Legal Business Name): ALEXANDRIA LATISHA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRIA LATISHA JONES

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 HOWE AVE
SACRAMENTO CA
95825-3912
US

IV. Provider business mailing address

740 PINO AVE
LANCASTER CA
93535-4561
US

V. Phone/Fax

Practice location:
  • Phone: 916-504-4040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT-01006646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: