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NPI Code Detail

MEDICARE: ALESIA WISE RDHAP

MEDICARE: ALESIA WISE RDHAP
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
1124Q00000XDental HygienistHAP 510CA

General Provider Information

NPI Number : 1649688045
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALESIA WISE RDHAP
Provider Business Mailing Address
First Line : 1253 BROADWAY
Second Line : #418
City : EL CAJON
State : CA
Zip : 92021-4902
Country : US
Telephone Number : 760-333-9792
Fax Number :
Provider Business Practice Location Address
First Line : 1253 BROADWAY
Second Line : #418
City : EL CAJON
State : CA
Zip : 92021-4902
Country : US
Telephone Number : 760-333-9792
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2014
Last Update Date : 07/29/2014

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Directions to “ ALESIA WISE RDHAP” Practice Location

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