Healthcare Provider Details

I. General information

NPI: 1023682234
Provider Name (Legal Business Name): ALICIA CORINA LOERA MONTANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21455 BIRCH ST # 210
HAYWARD CA
94541-2165
US

IV. Provider business mailing address

1904 102ND AVE
OAKLAND CA
94603-3314
US

V. Phone/Fax

Practice location:
  • Phone: 510-268-3770
  • Fax:
Mailing address:
  • Phone: 510-219-7909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number165444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: