Healthcare Provider Details

I. General information

NPI: 1730957085
Provider Name (Legal Business Name): ALYSSA MARIE ZAJDEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1832 ALPINE BLVD
ALPINE CA
91901-2107
US

IV. Provider business mailing address

12 WHEELWRIGHT LN
CHERRY HILL NJ
08003-1433
US

V. Phone/Fax

Practice location:
  • Phone: 619-326-4445
  • Fax:
Mailing address:
  • Phone:
  • 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: