Healthcare Provider Details

I. General information

NPI: 1134620016
Provider Name (Legal Business Name): ALYSSA ROSE CANTU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7339 N 1ST ST
FRESNO CA
93720-2954
US

IV. Provider business mailing address

1101 GETTYSBURG AVE APT 1197
CLOVIS CA
93612-3973
US

V. Phone/Fax

Practice location:
  • Phone: 559-229-1540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: