Healthcare Provider Details

I. General information

NPI: 1720818974
Provider Name (Legal Business Name): ALYSSA GREER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N PRAIRIE AVE
INGLEWOOD CA
90301-4501
US

IV. Provider business mailing address

145 W DEL MAR BLVD UNIT 4094
PASADENA CA
91105-4711
US

V. Phone/Fax

Practice location:
  • Phone: 310-677-7808
  • Fax:
Mailing address:
  • Phone: 805-558-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: