Healthcare Provider Details

I. General information

NPI: 1659970895
Provider Name (Legal Business Name): MR. DARRIAN L ALCORN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 N BLYTHE AVE
FRESNO CA
93722-5402
US

IV. Provider business mailing address

3433 W SHAW AVE STE 108
FRESNO CA
93711-3229
US

V. Phone/Fax

Practice location:
  • Phone: 559-277-3494
  • Fax:
Mailing address:
  • Phone: 559-558-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-113913
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: