Provider Demographics
NPI:1851011829
Name:VILLA, ALYSSA SARAHI
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:SARAHI
Last Name:VILLA
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 1:28134 BLOSSOMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8733
Mailing Address - Country:US
Mailing Address - Phone:951-388-7342
Mailing Address - Fax:
Practice Address - Street 1:4105 SIDMOUTH CT
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-5250
Practice Address - Country:US
Practice Address - Phone:951-388-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20060900643700Medicaid