Healthcare Provider Details

I. General information

NPI: 1629529128
Provider Name (Legal Business Name): ALLIZA ANNE CABRERA KANGLEON M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 BUTCHER RD STE B
VACAVILLE CA
95687-5685
US

IV. Provider business mailing address

875 HELMSLEY DRIVE
VACAVILLE CA
95687-8260
US

V. Phone/Fax

Practice location:
  • Phone: 707-305-1118
  • Fax:
Mailing address:
  • Phone: 707-342-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-25585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: