Provider Demographics
NPI:1508335860
Name:AGBAYANI, ALYSSA (BA)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:AGBAYANI
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15826 VIA ARROYO
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-2527
Mailing Address - Country:US
Mailing Address - Phone:510-432-7557
Mailing Address - Fax:
Practice Address - Street 1:15826 VIA ARROYO
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-2527
Practice Address - Country:US
Practice Address - Phone:510-432-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician