Provider Demographics
NPI:1992254551
Name:RICCI, ALEXIS
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:RICCI
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 1:2150 S ARIZONA AVE
Mailing Address - Street 2:APT 1081
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7725
Mailing Address - Country:US
Mailing Address - Phone:602-435-9237
Mailing Address - Fax:602-896-2580
Practice Address - Street 1:2150 S ARIZONA AVE
Practice Address - Street 2:APT 1081
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-7725
Practice Address - Country:US
Practice Address - Phone:602-435-9237
Practice Address - Fax:602-896-2580
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7709498385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child