Healthcare Provider Details

I. General information

NPI: 1538715446
Provider Name (Legal Business Name): ALYSSA KRISTIANNA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 HARRISON ST
RIVERSIDE CA
92503-3523
US

IV. Provider business mailing address

3933 HARRISON ST
RIVERSIDE CA
92503-3523
US

V. Phone/Fax

Practice location:
  • Phone: 833-391-0505
  • Fax:
Mailing address:
  • Phone: 833-391-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: