Provider Demographics
NPI:1306251707
Name:VASQUEZ, ALYSSIA RAQUEL SEGURA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ALYSSIA
Middle Name:RAQUEL SEGURA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALYSSIA
Other - Middle Name:RAQUEL
Other - Last Name:SEGURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13245 CHUKAR CT
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3899
Mailing Address - Country:US
Mailing Address - Phone:909-802-3901
Mailing Address - Fax:
Practice Address - Street 1:14772 PIPELINE AVE
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6027
Practice Address - Country:US
Practice Address - Phone:909-606-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13132225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist