Provider Demographics
NPI:1285005678
Name:HEREDIA, ALEXIS ELENA
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ELENA
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9719 LINCOLN VILLAGE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3330
Mailing Address - Country:US
Mailing Address - Phone:916-485-4175
Mailing Address - Fax:
Practice Address - Street 1:9719 LINCOLN VILLAGE DR STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3330
Practice Address - Country:US
Practice Address - Phone:916-485-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health