Healthcare Provider Details

I. General information

NPI: 1861034993
Provider Name (Legal Business Name): ALYSSA DILAURO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SANDPOINTE AVE STE 130
SANTA ANA CA
92707-5785
US

IV. Provider business mailing address

201 1ST ST APT 2
HUNTINGTON BEACH CA
92648-5321
US

V. Phone/Fax

Practice location:
  • Phone: 714-557-9292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number297000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: