Healthcare Provider Details

I. General information

NPI: 1538932165
Provider Name (Legal Business Name): ALYSSA RENAE AHUMADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 10/14/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E CHESTNUT AVE
SANTA ANA CA
92701-6322
US

IV. Provider business mailing address

1801 TOWN AND COUNTRY DR UNIT 5733
NORCO CA
92860-8187
US

V. Phone/Fax

Practice location:
  • Phone: 714-558-5501
  • Fax:
Mailing address:
  • Phone:
  • 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: