Healthcare Provider Details

I. General information

NPI: 1720460819
Provider Name (Legal Business Name): ALYSSA PABELLE DIPALAC VIVAS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 S VAL VISTA DR STE B105
GILBERT AZ
85297-7319
US

IV. Provider business mailing address

3530 S VAL VISTA DR STE B105
GILBERT AZ
85297-7319
US

V. Phone/Fax

Practice location:
  • Phone: 855-776-7266
  • Fax: 480-878-0610
Mailing address:
  • Phone: 855-776-7266
  • Fax: 480-878-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number007363
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2590
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: