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NPI Code Detail

MEDICARE: ALISA PROSTEK B.A. SLPA

MEDICARE: ALISA PROSTEK B.A. SLPA
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
12355S0801XSpeech-Language Assistant1490CA

General Provider Information

NPI Number : 1184069916
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISA PROSTEK B.A. SLPA
Provider Business Mailing Address
First Line : 7840 MISSION CENTER CT STE 200
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1320
Country : US
Telephone Number : 619-692-0622
Fax Number :
Provider Business Practice Location Address
First Line : 7840 MISSION CENTER CT STE 200
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1320
Country : US
Telephone Number : 619-692-0622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2013
Last Update Date : 05/07/2013

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