MEDICARE: ALEX ALBERTO MOTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	0-19-9805	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0-19-9805	OTHER	CA	BEHAVIOR ANALYST CERTIFICATION BOARD

General Provider Information

NPI Number	:	1700434339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX ALBERTO MOTA

Provider Business Mailing Address
First Line	:	222 E LAS TUNAS DR
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1404
Country	:	US
Telephone Number	:	626-320-1317
Fax Number	:	626-251-4266

Provider Business Practice Location Address
First Line	:	222 E LAS TUNAS DR
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1404
Country	:	US
Telephone Number	:	626-320-1317
Fax Number	:	626-251-4266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	08/27/2019

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