Provider Demographics
NPI:1427730647
Name:MAURO, ALYSSA VERONICA (DPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:VERONICA
Last Name:MAURO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:VERONICA
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1814 OAKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1321
Mailing Address - Country:US
Mailing Address - Phone:702-496-9015
Mailing Address - Fax:
Practice Address - Street 1:41421 DATE ST STE 101
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-7079
Practice Address - Country:US
Practice Address - Phone:855-454-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist