Healthcare Provider Details

I. General information

NPI: 1235812736
Provider Name (Legal Business Name): ALEXANDER JEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BOLLINGER CANYON LN STE A
SAN RAMON CA
94582-4592
US

IV. Provider business mailing address

27933 E 11TH ST
HAYWARD CA
94544-4813
US

V. Phone/Fax

Practice location:
  • Phone: 925-735-6414
  • Fax:
Mailing address:
  • Phone: 510-332-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number52750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: