Healthcare Provider Details

I. General information

NPI: 1619883824
Provider Name (Legal Business Name): ALEXANDER SCOTT HILBERT SUDRC, 26017
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 LIVE OAK BLVD STE A
YUBA CITY CA
95991-4028
US

IV. Provider business mailing address

1002 LIVE OAK BLVD STE A
YUBA CITY CA
95991-4028
US

V. Phone/Fax

Practice location:
  • Phone: 530-531-8754
  • Fax:
Mailing address:
  • Phone: 530-531-8754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number26017
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: