Healthcare Provider Details

I. General information

NPI: 1447919378
Provider Name (Legal Business Name): ALLYSA STONE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8078 E SANTA ANA CANYON RD
ANAHEIM CA
92808-1108
US

IV. Provider business mailing address

8078 E SANTA ANA CANYON RD
ANAHEIM CA
92808-1108
US

V. Phone/Fax

Practice location:
  • Phone: 714-974-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95174334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: