Provider Demographics
NPI:1316450828
Name:PATEL, ALYSON ALEXIS IBE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ALYSON
Middle Name:ALEXIS IBE
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:919 S WESTERN AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2333 LAKE AVE FL 2
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2463
Practice Address - Country:US
Practice Address - Phone:626-794-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA55414363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant