Healthcare Provider Details

I. General information

NPI: 1881371284
Provider Name (Legal Business Name): ALYSSA TIJERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 LAKEWOOD AVE APT 140
MODESTO CA
95355-3579
US

IV. Provider business mailing address

1401 LAKEWOOD AVE APT 140
MODESTO CA
95355-3579
US

V. Phone/Fax

Practice location:
  • Phone: 408-422-8804
  • Fax:
Mailing address:
  • Phone: 408-422-8804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: