Provider Demographics
NPI:1740755651
Name:YRUEGAS, ALYSSA ANN (MASSMA60895773)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:ANN
Last Name:YRUEGAS
Suffix:
Gender:F
Credentials:MASSMA60895773
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2853
Mailing Address - Country:US
Mailing Address - Phone:509-990-4132
Mailing Address - Fax:
Practice Address - Street 1:2108 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2853
Practice Address - Country:US
Practice Address - Phone:509-990-4132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-06
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMASS.MA.60895773225700000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice