Provider Demographics
NPI:1811341175
Name:ARAUJO, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:ARAUJO
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 1:1424 30TH ST STE G
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-3421
Mailing Address - Country:US
Mailing Address - Phone:619-565-2650
Mailing Address - Fax:
Practice Address - Street 1:1424 30TH ST STE G
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-3421
Practice Address - Country:US
Practice Address - Phone:619-565-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$Medicaid