Provider Demographics
NPI:1376637926
Name:WILLENS-DAVIS, ALISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:
Last Name:WILLENS-DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 VISTA GRANDE TERRACE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084
Mailing Address - Country:US
Mailing Address - Phone:760-758-0522
Mailing Address - Fax:
Practice Address - Street 1:2103 EL CAMINO REAL
Practice Address - Street 2:SUITE 203
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054
Practice Address - Country:US
Practice Address - Phone:760-599-7833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY130640Medicaid
CAPSY13064OtherSTATE LICENSE NUMBER
CAR16323Medicare UPIN
CACP13064Medicare ID - Type Unspecified