Healthcare Provider Details

I. General information

NPI: 1578131918
Provider Name (Legal Business Name): ALYSSA YAMAMURA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2021
Last Update Date: 11/02/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 W RIO SALADO PKWY STE 107
TEMPE AZ
85281-2892
US

IV. Provider business mailing address

1255 W RIO SALADO PKWY STE 107
TEMPE AZ
85281-2892
US

V. Phone/Fax

Practice location:
  • Phone: 480-962-0071
  • Fax:
Mailing address:
  • Phone: 480-962-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: