Healthcare Provider Details

I. General information

NPI: 1508790064
Provider Name (Legal Business Name): ALYSSA CARDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SPRING ST STE 104
LA MESA CA
91942-0272
US

IV. Provider business mailing address

4700 SPRING ST STE 104
LA MESA CA
91942-0272
US

V. Phone/Fax

Practice location:
  • Phone: 619-782-0700
  • Fax:
Mailing address:
  • Phone: 619-782-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-543646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: