Healthcare Provider Details

I. General information

NPI: 1124815402
Provider Name (Legal Business Name): ALYSSA DE LA TEJA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 N VALENTINE AVE
FRESNO CA
93722-5553
US

IV. Provider business mailing address

4820 E SANTA ANA AVE
FRESNO CA
93726-1515
US

V. Phone/Fax

Practice location:
  • Phone: 559-276-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: