Provider Demographics
NPI:1528754876
Name:GONZALEZ, ALYSSA
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GONZALEZ
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 1:221 W CREST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1735
Mailing Address - Country:US
Mailing Address - Phone:760-744-3672
Mailing Address - Fax:760-744-6182
Practice Address - Street 1:221 W CREST ST STE 100
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1735
Practice Address - Country:US
Practice Address - Phone:760-744-3672
Practice Address - Fax:760-744-6182
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist