Provider Demographics
NPI:1851967897
Name:SIBRIAN, ALYSA MICHELLE
Entity type:Individual
Prefix:MRS
First Name:ALYSA
Middle Name:MICHELLE
Last Name:SIBRIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSA
Other - Middle Name:MICHELLE
Other - Last Name:MACIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23085 CANYON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-7637
Mailing Address - Country:US
Mailing Address - Phone:909-455-8940
Mailing Address - Fax:
Practice Address - Street 1:1430 E COOLEY DR STE 240
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3936
Practice Address - Country:US
Practice Address - Phone:800-675-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician