Healthcare Provider Details

I. General information

NPI: 1417872730
Provider Name (Legal Business Name): ALYSSA VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 FAIRMONT DR BLDG B
CASTRO VALLEY CA
94578-1001
US

IV. Provider business mailing address

257 GANNON RD
OAKLAND CA
94603-1053
US

V. Phone/Fax

Practice location:
  • Phone: 510-483-3030
  • Fax:
Mailing address:
  • Phone: 510-561-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: