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NPI Code Detail

MEDICARE: MS. ALYSSA MICHELLE DUBIN

MEDICARE: MS. ALYSSA MICHELLE DUBIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1316249915
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ALYSSA MICHELLE DUBIN
Provider Business Mailing Address
First Line : 18100 ROSCOE BLVD APT 8
Second Line :
City : NORTHRIDGE
State : CA
Zip : 91325-4250
Country : US
Telephone Number : 818-512-6082
Fax Number :
Provider Business Practice Location Address
First Line : 1453 16TH ST
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-2715
Country : US
Telephone Number : 310-264-6646
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2010
Last Update Date : 12/04/2015

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