Individual
ALISSA ANNE DETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 MEDICAL PLZ, 420, LOS ANGELES, CA 90095-0001
(310) 794-9809
(310) 206-3551
Mailing address
200 MEDICAL PLZ, 420, LOS ANGELES, CA 90095-0001
(310) 794-9809
(310) 206-3551
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A110966
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811211626
MEDI-CAL CCS PANELED PROVIDER
CA
05
—
1811211626
—
CA
Enumeration date
03/23/2010
Last updated
08/31/2012
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