Provider Demographics
NPI:1225306111
Name:NELLA, ALEXANDER STEFANO (PA-C, RD, CDCES)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:STEFANO
Last Name:NELLA
Suffix:
Gender:M
Credentials:PA-C, RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 STOCKTON BLVD STE 384
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2208
Mailing Address - Country:US
Mailing Address - Phone:916-734-7098
Mailing Address - Fax:916-734-7070
Practice Address - Street 1:2516 STOCKTON BLVD STE 384
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2208
Practice Address - Country:US
Practice Address - Phone:916-734-7098
Practice Address - Fax:916-734-7070
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
CA60388363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered