Healthcare Provider Details

I. General information

NPI: 1275275737
Provider Name (Legal Business Name): ALICIA MIZES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 LENNON LN STE 295
WALNUT CREEK CA
94598-2563
US

IV. Provider business mailing address

255 KING ST APT 523
SAN FRANCISCO CA
94107-5443
US

V. Phone/Fax

Practice location:
  • Phone: 925-357-9786
  • Fax:
Mailing address:
  • Phone: 585-737-8163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA210142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: