Healthcare Provider Details

I. General information

NPI: 1699648782
Provider Name (Legal Business Name): ALYSSA FERRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 01/31/2026
Certification Date: 01/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 SUNNY CREST DR STE 2600
FULLERTON CA
92835-3644
US

IV. Provider business mailing address

1950 SUNNY CREST DR STE 2600
FULLERTON CA
92835-3644
US

V. Phone/Fax

Practice location:
  • Phone: 714-446-5590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95032364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: