Healthcare Provider Details

I. General information

NPI: 1912836990
Provider Name (Legal Business Name): ALISE AZURE RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AZURE RICHARDSON

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 N BROOKHURST ST
ANAHEIM CA
92801-5620
US

IV. Provider business mailing address

16710 ORANGE AVE UNIT D22
PARAMOUNT CA
90723-6844
US

V. Phone/Fax

Practice location:
  • Phone: 562-754-2377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: