Provider Demographics
NPI:1457082828
Name:FOX, ALYSSA M (RN)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:M
Last Name:FOX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 CAHUILLA ST APT 66
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4743
Mailing Address - Country:US
Mailing Address - Phone:909-543-5867
Mailing Address - Fax:
Practice Address - Street 1:3151 AIRWAY AVE STE E1
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4620
Practice Address - Country:US
Practice Address - Phone:949-375-7084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95268266163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse