Healthcare Provider Details

I. General information

NPI: 1356214191
Provider Name (Legal Business Name): ALYSSA RAINE CAMPOS-LAURENTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WILSHIRE BLVD STE 310
SANTA MONICA CA
90403-5683
US

IV. Provider business mailing address

2001 WILSHIRE BLVD STE 310
SANTA MONICA CA
90403-5683
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-3320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number28262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: