Healthcare Provider Details

I. General information

NPI: 1619707007
Provider Name (Legal Business Name): ALYSSA RENE DUENEZ-ROCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2500 REDHILL AVE STE 100
SANTA ANA CA
92705-5518
US

IV. Provider business mailing address

423 JULIE ST
COLTON CA
92324-1337
US

V. Phone/Fax

Practice location:
  • Phone: 949-748-8571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number26536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: