Healthcare Provider Details

I. General information

NPI: 1740813906
Provider Name (Legal Business Name): ALISON HALEY ALONSO BCBA 1-23-70117
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CENTENNIAL WAY
TUSTIN CA
92780-3714
US

IV. Provider business mailing address

1151 WALNUT AVE APT 95
TUSTIN CA
92780-5659
US

V. Phone/Fax

Practice location:
  • Phone: 949-366-5665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-70117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: