MEDICARE: ALYSSA NICOLE HEWITT CLC

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	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1831869072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA NICOLE HEWITT CLC

Provider Business Mailing Address
First Line	:	5403 E MEZZANINE WAY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3539
Country	:	US
Telephone Number	:	310-489-8543
Fax Number	:

Provider Business Practice Location Address
First Line	:	5403 E MEZZANINE WAY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3539
Country	:	US
Telephone Number	:	310-489-8543
Fax Number	:

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

Provider Enumeration Date	:	09/19/2021
Last Update Date	:	09/19/2021

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