Provider Demographics
NPI:1760923502
Name:BISARYA, ALAN
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:BISARYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4679 TORREY CIRCLE
Mailing Address - Street 2:APT #D-201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-8915
Mailing Address - Country:US
Mailing Address - Phone:415-729-5714
Mailing Address - Fax:
Practice Address - Street 1:5405 MOREHOUSE DRIVE
Practice Address - Street 2:SUITE #120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4723
Practice Address - Country:US
Practice Address - Phone:415-729-5714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96372106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist