Provider Demographics
NPI:1477674000
Name:DONHARDT, ALICIA
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:
Last Name:DONHARDT
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 1:3176 CEDAR RAVINE RD.
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4546
Mailing Address - Country:US
Mailing Address - Phone:530-622-6747
Mailing Address - Fax:
Practice Address - Street 1:941 SPRING ST
Practice Address - Street 2:STE. 7
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4546
Practice Address - Country:US
Practice Address - Phone:530-621-6236
Practice Address - Fax:530-295-2589
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health