Healthcare Provider Details

I. General information

NPI: 1386494664
Provider Name (Legal Business Name): ALLYSON PATRICIA WEINHOLD ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 E FRUIT ST
SANTA ANA CA
92701-4296
US

IV. Provider business mailing address

616 MASSELIN AVE APT 303
LOS ANGELES CA
90036-3733
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-9373
  • Fax:
Mailing address:
  • Phone: 541-554-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number113419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: