Healthcare Provider Details

I. General information

NPI: 1437761202
Provider Name (Legal Business Name): GRANT ALEXANDER CONTRERAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 ARTESIA BLVD
HERMOSA BEACH CA
90254-2707
US

IV. Provider business mailing address

982 ARTESIA BLVD
HERMOSA BEACH CA
90254-2707
US

V. Phone/Fax

Practice location:
  • Phone: 707-219-8972
  • Fax:
Mailing address:
  • Phone: 707-219-8972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: