Healthcare Provider Details

I. General information

NPI: 1518681808
Provider Name (Legal Business Name): ALEXANDER DUARTE-BRAVO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 S. ACADEMY AVE.
KINGSBURG CA
93631
US

IV. Provider business mailing address

218 N PALM ST
WOODLAKE CA
93286-1425
US

V. Phone/Fax

Practice location:
  • Phone: 559-556-0030
  • Fax:
Mailing address:
  • Phone: 559-798-7907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: