Healthcare Provider Details

I. General information

NPI: 1982223889
Provider Name (Legal Business Name): ALYSSA VICTORIA EADE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2059
US

IV. Provider business mailing address

1000 W CARSON ST # 461
TORRANCE CA
90502-2059
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-8070
  • Fax:
Mailing address:
  • Phone: 424-306-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: