Healthcare Provider Details

I. General information

NPI: 1669798203
Provider Name (Legal Business Name): ALYSSA GELRUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E CHAPMAN AVE SUITE NUMBER 203
FULLERTON CA
92831-3839
US

IV. Provider business mailing address

6179 E PASEO RIO VERDE
ANAHEIM CA
92807-2351
US

V. Phone/Fax

Practice location:
  • Phone: 714-680-8257
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: