Healthcare Provider Details

I. General information

NPI: 1487072922
Provider Name (Legal Business Name): ALECIA GREENLEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3569 ROUND BARN CIR
SANTA ROSA CA
95403-5781
US

IV. Provider business mailing address

500 E HAMILTON AVE # 1020
CAMPBELL CA
95008-0210
US

V. Phone/Fax

Practice location:
  • Phone: 408-800-3149
  • Fax: 408-413-0463
Mailing address:
  • Phone: 408-800-3149
  • Fax: 408-413-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number336.107121
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number269603
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA169680
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberA169680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: