Provider Demographics
NPI:1316249915
Name:DUBIN, ALYSSA MICHELLE
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:MICHELLE
Last Name:DUBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18100 ROSCOE BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4250
Mailing Address - Country:US
Mailing Address - Phone:818-512-6082
Mailing Address - Fax:
Practice Address - Street 1:1453 16TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2715
Practice Address - Country:US
Practice Address - Phone:310-264-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator