Provider Demographics
NPI:1831836675
Name:SERPA, ALYSSA M (MA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:M
Last Name:SERPA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 BEACH BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1141
Mailing Address - Country:US
Mailing Address - Phone:559-331-4887
Mailing Address - Fax:
Practice Address - Street 1:940 S COAST DR STE 225
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7757
Practice Address - Country:US
Practice Address - Phone:949-743-1457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program