Provider Demographics
NPI:1811628480
Name:BIRST, ALYSSA KANANI
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KANANI
Last Name:BIRST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MAXWELL LN
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-3465
Mailing Address - Country:US
Mailing Address - Phone:760-855-6004
Mailing Address - Fax:
Practice Address - Street 1:2420 VISTA WAY STE 215
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6190
Practice Address - Country:US
Practice Address - Phone:442-266-8089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant