Healthcare Provider Details

I. General information

NPI: 1104339936
Provider Name (Legal Business Name): ALEJANDRA DANIELLE CERRITOS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E RINCON ST STE 219
CORONA CA
92879-1387
US

IV. Provider business mailing address

255 E RINCON ST STE 219
CORONA CA
92879-1387
US

V. Phone/Fax

Practice location:
  • Phone: 951-817-5328
  • Fax:
Mailing address:
  • Phone: 951-817-5328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-15-1008-16357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: