Provider Demographics
NPI:1366259640
Name:ARCHULETA, ALICIA ANN
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ANN
Last Name:ARCHULETA
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 1:375 CENTRAL AVE UNIT 199
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6594
Mailing Address - Country:US
Mailing Address - Phone:909-533-9809
Mailing Address - Fax:
Practice Address - Street 1:6377 RIVERSIDE AVE STE 203
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3155
Practice Address - Country:US
Practice Address - Phone:951-500-1087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist