Provider Demographics
NPI:1316679574
Name:ROTH, ALYSSA (MA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 REED AVE UNIT 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5352
Mailing Address - Country:US
Mailing Address - Phone:858-500-9315
Mailing Address - Fax:
Practice Address - Street 1:2271 ALPINE BLVD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-1100
Practice Address - Country:US
Practice Address - Phone:619-289-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program