Most Relevant Information
Provider Data
| NPI Number: | 1003643222 |
| Provider Name: | ALYSSA LEE JETMORE |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/19/2024 |
| Last Updated: | 09/19/2024 |
Provider Practice Location
1410 BONITA AVE
BERKELEY
CA
947091909
Practice Location Phone/Fax
| Phone: | 5105264765 |
| Fax: | 5105262887 |
Provider Mailing Location
450 RIDGEWOOD DR
MARTINEZ
CA
945534131
Provider Mailing Phone/Fax
| Phone: | 9707733032 |
| Fax: |