MEDICARE: ALYSSA M FOX RN

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	163W00000X	Registered Nurse	95268266	CA

General Provider Information

NPI Number	:	1457082828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA M FOX RN

Provider Business Mailing Address
First Line	:	2255 CAHUILLA ST APT 66
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-4743
Country	:	US
Telephone Number	:	909-543-5867
Fax Number	:

Provider Business Practice Location Address
First Line	:	3151 AIRWAY AVE STE E1
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4620
Country	:	US
Telephone Number	:	949-375-7084
Fax Number	:

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

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	06/17/2022

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Directions to “ ALYSSA M FOX RN” Practice Location

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