Provider Demographics
NPI:1083959571
Name:FERNANDEZ, ALYSSA M (CODA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:M
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:CODA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 MISSION CENTER CT
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1322
Mailing Address - Country:US
Mailing Address - Phone:619-578-2232
Mailing Address - Fax:619-578-2231
Practice Address - Street 1:7850 MISSION CENTER CT
Practice Address - Street 2:SUITE #100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1322
Practice Address - Country:US
Practice Address - Phone:619-578-2232
Practice Address - Fax:619-578-2231
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOTA2069224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant