Healthcare Provider Details

I. General information

NPI: 1437704145
Provider Name (Legal Business Name): ALISON LEIGH MOONEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4335 ATLANTIC AVE
LONG BEACH CA
90807-2803
US

IV. Provider business mailing address

24682 JEREMIAH DR
DANA POINT CA
92629-1096
US

V. Phone/Fax

Practice location:
  • Phone: 562-216-4900
  • Fax:
Mailing address:
  • Phone: 949-290-2806
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number848884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: