Healthcare Provider Details

I. General information

NPI: 1538387915
Provider Name (Legal Business Name): ALYSSA ANN WASHLAKE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 SKYPARK DRIVE STE 200
TORRANCE CA
90505
US

IV. Provider business mailing address

3701 SKYPARK DR STE 200
TORRANCE CA
90505-4753
US

V. Phone/Fax

Practice location:
  • Phone: 310-378-8900
  • Fax: 310-791-0789
Mailing address:
  • Phone: 310-378-8900
  • Fax: 310-791-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP15047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: