Healthcare Provider Details

I. General information

NPI: 1619733227
Provider Name (Legal Business Name): ALYSSA AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 OPAL ST APT 17
OAKLAND CA
94609-2671
US

IV. Provider business mailing address

810 5TH AVE STE 100
SAN RAFAEL CA
94901-3252
US

V. Phone/Fax

Practice location:
  • Phone: 760-554-9773
  • Fax:
Mailing address:
  • Phone: 415-870-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: