MEDICARE: ALEXIS ALBERTA BAEZ

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	101YA0400X	CA

General Provider Information

NPI Number	:	1578448577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS ALBERTA BAEZ

Provider Business Mailing Address
First Line	:	10898 BOESSOW RD
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-8451
Country	:	US
Telephone Number	:	209-882-2112
Fax Number	:

Provider Business Practice Location Address
First Line	:	3818 MADISON AVE APT 19
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5061
Country	:	US
Telephone Number	:	209-882-2112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2025
Last Update Date	:	01/01/2026

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