Healthcare Provider Details

I. General information

NPI: 1225966757
Provider Name (Legal Business Name): ANA MILENA ALICEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E 3RD ST STE 200
BETHLEHEM PA
18015-2072
US

IV. Provider business mailing address

511 E 3RD ST STE 200
BETHLEHEM PA
18015-2072
US

V. Phone/Fax

Practice location:
  • Phone: 484-225-3732
  • Fax: 484-225-3732
Mailing address:
  • Phone: 484-225-3732
  • Fax: 484-225-3732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number21386
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: