Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MT211203 | PA |
Y | 2081S0010X | Sports Medicine | A161294 | CA |
Y | 213ES0000X | Sports Medicine | A161294 | CA |
NPI | 1396126249 |
---|---|
Provider Name | Alyssa Speciale |
First Address | Sacramento, CA 95817-2307 |
Second Address | Sacramento, CA 95816-3384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2015 |
Last Update Date | 20/07/2020 |