Provider Demographics
NPI:1588262901
Name:LAU-YLLESCAS, ALICE KA
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:KA
Last Name:LAU-YLLESCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICE KA
Other - Middle Name:
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 33568
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3568
Mailing Address - Country:US
Mailing Address - Phone:949-833-2237
Mailing Address - Fax:619-374-7134
Practice Address - Street 1:1855 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2623
Practice Address - Country:US
Practice Address - Phone:855-223-7123
Practice Address - Fax:619-374-7134
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician