Healthcare Provider Details

I. General information

NPI: 1194303750
Provider Name (Legal Business Name): ALYSSA MATHEW-JOSEPH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 E MAIN ST STE 102
SANTA MARIA CA
93454-4813
US

IV. Provider business mailing address

1414 E MAIN ST STE 102
SANTA MARIA CA
93454-4813
US

V. Phone/Fax

Practice location:
  • Phone: 805-548-1550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number20A22492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: