Healthcare Provider Details

I. General information

NPI: 1164093258
Provider Name (Legal Business Name): ALYSSA HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA PHILLIPS

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19782 MACARTHUR BLVD STE 310
IRVINE CA
92612-2417
US

IV. Provider business mailing address

17542 COTTONWOOD
IRVINE CA
92612-2808
US

V. Phone/Fax

Practice location:
  • Phone: 949-929-9248
  • Fax:
Mailing address:
  • Phone: 614-940-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: