Provider Demographics
NPI:1184463531
Name:WIDICK, ALYSSA JOANN
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JOANN
Last Name:WIDICK
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 1:600 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2118
Mailing Address - Country:US
Mailing Address - Phone:209-500-7702
Mailing Address - Fax:
Practice Address - Street 1:1929 OXFORD CT
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-2184
Practice Address - Country:US
Practice Address - Phone:831-771-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator