Healthcare Provider Details

I. General information

NPI: 1437089844
Provider Name (Legal Business Name): ALYSSA MARIA GRANT CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2263 N LAKEWOOD BLVD STE 200
LONG BEACH CA
90815-2519
US

IV. Provider business mailing address

8431 HOLDER ST
BUENA PARK CA
90620-3003
US

V. Phone/Fax

Practice location:
  • Phone: 714-333-0669
  • Fax:
Mailing address:
  • Phone: 530-220-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: