Healthcare Provider Details

I. General information

NPI: 1679089767
Provider Name (Legal Business Name): ALICIA IGARTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 WHITEBOOK DR
LA HABRA CA
90631
US

IV. Provider business mailing address

890 WHITEBOOK DR
LA HABRA CA
90631-6410
US

V. Phone/Fax

Practice location:
  • Phone: 562-458-0629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: