Provider Demographics
NPI:1417018086
Name:ALEXIS, RAOUL III
Entity Type:Individual
Prefix:MR
First Name:RAOUL
Middle Name:
Last Name:ALEXIS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 DARLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-4300
Mailing Address - Country:US
Mailing Address - Phone:707-558-1600
Mailing Address - Fax:707-558-1606
Practice Address - Street 1:1027 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4511
Practice Address - Country:US
Practice Address - Phone:707-558-1600
Practice Address - Fax:707-558-1606
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist