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General NPI Number Information
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NPI Number | 1891232484
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Entity Type | Organization
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Legal Business Name | PERSONALIZED CARE MD
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 3010 BEARD RD
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City | NAPA
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State | CA
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Zip | 94558-3442
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Country | US
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Telephone | 707-255-8825
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Fax | 707-252-9325
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Provider Business Mailing Address
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Address Line | 3010 BEARD RD
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City | NAPA
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State | CA
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Zip | 94558-3442
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Country | US
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Telephone | 707-255-8825
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Fax | 707-252-9325
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEXANDRE ANTONIO DE MORAES
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Credential | MD
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Telephone | 707-255-8825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | A66851
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License Number State | CA
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