Provider Demographics
NPI:1225586811
Name:WASKLEWICZ, ALICIA (MPA)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:
Last Name:WASKLEWICZ
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 TRUXEL RD APT 1116
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3742
Mailing Address - Country:US
Mailing Address - Phone:602-228-3659
Mailing Address - Fax:
Practice Address - Street 1:25 N COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-6609
Practice Address - Country:US
Practice Address - Phone:530-661-2928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator