Provider Demographics
NPI:1215426283
Name:CORRELL, ALICJA (DO)
Entity type:Individual
Prefix:
First Name:ALICJA
Middle Name:
Last Name:CORRELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 STONE BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-4055
Mailing Address - Country:US
Mailing Address - Phone:916-371-4939
Mailing Address - Fax:
Practice Address - Street 1:2101 STONE BLVD STE 190
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-4055
Practice Address - Country:US
Practice Address - Phone:916-371-4939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-06
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A18883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine