Provider Demographics
NPI:1295464634
Name:ANASTASHA, ALLESSANDRA
Entity Type:Individual
Prefix:
First Name:ALLESSANDRA
Middle Name:
Last Name:ANASTASHA
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 1:175 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0430
Mailing Address - Country:US
Mailing Address - Phone:909-387-8304
Mailing Address - Fax:
Practice Address - Street 1:175 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-8309
Practice Address - Country:US
Practice Address - Phone:909-387-8304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker