MEDICARE: MS. ALISA ROCHELLE MOWRY

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	103K00000X	Behavior Analyst	1-17-26657	CA

General Provider Information

NPI Number	:	1700306396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALISA ROCHELLE MOWRY

Provider Business Mailing Address
First Line	:	2495 OSBORNE TER
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92084-1813
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3702 RUFFIN RD STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1893
Country	:	US
Telephone Number	:	619-297-4300
Fax Number	:

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

Provider Enumeration Date	:	06/23/2017
Last Update Date	:	10/18/2022

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