Healthcare Provider Details

I. General information

NPI: 1952872236
Provider Name (Legal Business Name): ALEXANDRA MONTENEGRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CONCORD AVE STE 100
CONCORD CA
94520-4969
US

IV. Provider business mailing address

8160 CARDIFF DR
STANTON CA
90680-3912
US

V. Phone/Fax

Practice location:
  • Phone: 714-661-4021
  • Fax:
Mailing address:
  • Phone: 714-206-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: