Healthcare Provider Details

I. General information

NPI: 1639631567
Provider Name (Legal Business Name): ALYSSA N DEBELLIS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 BEVERLY BLVD STE 250
WEST HOLLYWOOD CA
90048-2438
US

IV. Provider business mailing address

3569 VINTON AVE APT 210
LOS ANGELES CA
90034-4870
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-2641
  • Fax:
Mailing address:
  • Phone: 315-289-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: