Provider Demographics
NPI:1649297706
Name:WALL, ALESSANDRA SA
Entity type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:SA
Last Name:WALL
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 1:311 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1630
Mailing Address - Country:US
Mailing Address - Phone:858-352-8027
Mailing Address - Fax:619-231-1050
Practice Address - Street 1:311 LAUREL ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1630
Practice Address - Country:US
Practice Address - Phone:858-352-8027
Practice Address - Fax:619-231-1050
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20775103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist