Provider Demographics
NPI:1326683269
Name:POLEHONKI, ALISSA ROBLES (LVN)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:ROBLES
Last Name:POLEHONKI
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 S FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3415
Mailing Address - Country:US
Mailing Address - Phone:714-978-6682
Mailing Address - Fax:
Practice Address - Street 1:985 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4067
Practice Address - Country:US
Practice Address - Phone:949-646-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA705331164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse