Healthcare Provider Details

I. General information

NPI: 1023550621
Provider Name (Legal Business Name): ALEXANDER VIGOUREUX M.A., BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11910 BOYETTE RD
RIVERVIEW FL
33569-5601
US

IV. Provider business mailing address

13645 LARAWAY DR
RIVERVIEW FL
33579-7137
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-2070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: