Healthcare Provider Details

I. General information

NPI: 1881165298
Provider Name (Legal Business Name): LORENA ALCANTAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5558 CALIFORNIA AVE
BAKERSFIELD CA
93309-0705
US

IV. Provider business mailing address

1119 CRYSTAL ST
PORTERVILLE CA
93257-5811
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-1577
  • Fax:
Mailing address:
  • Phone: 559-339-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: