Healthcare Provider Details

I. General information

NPI: 1730692211
Provider Name (Legal Business Name): ALEXANDRA VICTORIA OLLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA VICTORIA OLLES BCABA, BCBA

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 08/24/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7964 OAK RUN CIR
LAKELAND FL
33809-7252
US

IV. Provider business mailing address

7964 OAK RUN CIR
LAKELAND FL
33809-7252
US

V. Phone/Fax

Practice location:
  • Phone: 352-777-5766
  • Fax:
Mailing address:
  • Phone: 352-777-5766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-52422
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: