Provider Demographics
NPI:1730923616
Name:SEALES, ALICIA DENISE
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:DENISE
Last Name:SEALES
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 1:16000 YUCCA ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3517
Mailing Address - Country:US
Mailing Address - Phone:760-669-0300
Mailing Address - Fax:
Practice Address - Street 1:16000 YUCCA ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3517
Practice Address - Country:US
Practice Address - Phone:760-669-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker