MEDICARE: ALISA RENEE WALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	373H00000X	Day Training/Habilitation Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1023826419	OTHER	CA	TELECARE CORPORATION

General Provider Information

NPI Number	:	1073826160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA RENEE WALL

Provider Business Mailing Address
First Line	:	5121 STOCKDALE HWY STE 212
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-2664
Country	:	US
Telephone Number	:	661-473-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 STOCKDALE HWY STE 212
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-2664
Country	:	US
Telephone Number	:	661-473-1500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	04/07/2026

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Directions to “ ALISA RENEE WALL ” Practice Location

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