Healthcare Provider Details

I. General information

NPI: 1104945591
Provider Name (Legal Business Name): CAROL LOUISE ALESSO LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 110
OXNARD CA
93036-2665
US

IV. Provider business mailing address

1911 WILLIAMS DR STE 110
OXNARD CA
93036-2665
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-4200
  • Fax:
Mailing address:
  • Phone: 805-981-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberLPT30060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: