MEDICARE: MR. ALEXANDER JAY VANRIPER M.S.

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1710962667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEXANDER JAY VANRIPER M.S.

Provider Business Mailing Address
First Line	:	1650 RESPONSE RD
Second Line	:	3RD FLOOR, GENETICS DEPARTMENT
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4807
Country	:	US
Telephone Number	:	916-614-4792
Fax Number	:	916-614-4768

Provider Business Practice Location Address
First Line	:	1650 RESPONSE RD
Second Line	:	3RD FLOOR, GENETICS DEPARTMENT
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4807
Country	:	US
Telephone Number	:	916-614-4792
Fax Number	:	916-614-4768

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	12/30/2021

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