MEDICARE: ALEXY SADABA

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	171M00000X	Case Manager/Care Coordinator
2	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1811715022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXY SADABA

Provider Business Mailing Address
First Line	:	2691 GRAYSON CT
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-5023
Country	:	US
Telephone Number	:	818-317-7117
Fax Number	:

Provider Business Practice Location Address
First Line	:	10540 SHERMAN GROVE AVE
Second Line	:
City	:	SUNLAND
State	:	CA
Zip	:	91040-1913
Country	:	US
Telephone Number	:	818-352-5941
Fax Number	:

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

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	04/23/2025

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Directions to “ ALEXY SADABA ” Practice Location

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