Individual
ALISA LICON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
685 N 13TH AVE, UPLAND, CA 91786-4916
(909) 981-8383
Mailing address
685 N 13TH AVE STE 10, UPLAND, CA 91786-4963
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95036899
CA
Other
Enumeration date
02/17/2026
Last updated
02/17/2026
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