Healthcare Provider Details

I. General information

NPI: 1457255630
Provider Name (Legal Business Name): ALYISSA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 E RAY RD STE A204
CHANDLER AZ
85225-8720
US

IV. Provider business mailing address

1358 S HOWARD DR
YUMA AZ
85364-4149
US

V. Phone/Fax

Practice location:
  • Phone: 928-285-2374
  • Fax:
Mailing address:
  • Phone: 928-285-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17939
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: