Healthcare Provider Details

I. General information

NPI: 1497583835
Provider Name (Legal Business Name): ALYSSA LYNNETTE MARTINEZ-ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6426 W 5TH ST
LOS ANGELES CA
90048-4710
US

IV. Provider business mailing address

6426 W 5TH ST
LOS ANGELES CA
90048-4710
US

V. Phone/Fax

Practice location:
  • Phone: 323-825-7172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-324319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: