Healthcare Provider Details

I. General information

NPI: 1225306111
Provider Name (Legal Business Name): ALEXANDER STEFANO NELLA PA-C, RD, CDCES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 STOCKTON BLVD STE 384
SACRAMENTO CA
95817-2208
US

IV. Provider business mailing address

2516 STOCKTON BLVD STE 384
SACRAMENTO CA
95817-2208
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7098
  • Fax: 916-734-7070
Mailing address:
  • Phone: 916-734-7098
  • Fax: 916-734-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60388
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: