Healthcare Provider Details

I. General information

NPI: 1376485276
Provider Name (Legal Business Name): ALYSSA MONEI VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CALIFORNIA ST STE 140
REDLANDS CA
92374-2946
US

IV. Provider business mailing address

15665 LAS POSAS DR
MORENO VALLEY CA
92551-1991
US

V. Phone/Fax

Practice location:
  • Phone: 909-489-0779
  • Fax:
Mailing address:
  • Phone: 909-489-0779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95166242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: