Healthcare Provider Details

I. General information

NPI: 1639743115
Provider Name (Legal Business Name): ALEJANDRO CONTRERAS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEX CONTRERAS

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 OAK VALLEY DR
ANN ARBOR MI
48108-9674
US

IV. Provider business mailing address

1058 COLEMAN ST
YPSILANTI MI
48198-6308
US

V. Phone/Fax

Practice location:
  • Phone: 734-222-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: