Healthcare Provider Details

I. General information

NPI: 1992640916
Provider Name (Legal Business Name): ALYSSA BRIANNA SEGOVIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5431 JEFFERSON AVE
CHINO CA
91710-3517
US

IV. Provider business mailing address

13461 RAMONA AVE
CHINO CA
91710-5029
US

V. Phone/Fax

Practice location:
  • Phone: 909-627-7351
  • Fax:
Mailing address:
  • Phone: 909-628-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14532311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: