Healthcare Provider Details

I. General information

NPI: 1114783602
Provider Name (Legal Business Name): ALYSSA RAYLENE LIGORRIA-TORRES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 E RINCON ST
CORONA CA
92879-1366
US

IV. Provider business mailing address

786 CAMEO CT
POMONA CA
91766-6236
US

V. Phone/Fax

Practice location:
  • Phone: 562-821-1491
  • Fax:
Mailing address:
  • Phone: 909-631-9732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: