Healthcare Provider Details

I. General information

NPI: 1053990051
Provider Name (Legal Business Name): ALYSZA KRISTINE PERMALINO OKAZAKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSZA KRISTINE URETA PERMALINO PA-C

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 11/13/2022
Certification Date: 11/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E CESAR E CHAVEZ AVE STE 1400
LOS ANGELES CA
90033-2467
US

IV. Provider business mailing address

1700 E CESAR E CHAVEZ AVE STE 1400
LOS ANGELES CA
90033-2467
US

V. Phone/Fax

Practice location:
  • Phone: 323-307-8913
  • Fax: 323-881-8645
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: