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NPI Code Detail

MEDICARE: ALEXIS R TAIVITI

MEDICARE: ALEXIS R TAIVITI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker
2373H00000XDay Training/Habilitation Specialist

General Provider Information

NPI Number : 1558914028
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS R TAIVITI
Provider Business Mailing Address
First Line : 620 N AURORA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-2343
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6060 SUNRISE VISTA DR STE 2100
Second Line :
City : CITRUS HEIGHTS
State : CA
Zip : 95610-7068
Country : US
Telephone Number : 916-967-6253
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2019
Last Update Date : 03/31/2025

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Directions to “ ALEXIS R TAIVITI ” Practice Location

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