Healthcare Provider Details

I. General information

NPI: 1508407925
Provider Name (Legal Business Name): ALESSANDRA FOBES BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALESSANDRA BAKER

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9051 FLORIDA MINING BLVD STE 102
TAMPA FL
33634-1240
US

IV. Provider business mailing address

9051 FLORIDA MINING BLVD STE 102
TAMPA FL
33634-1240
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-2070
  • Fax: 813-337-0937
Mailing address:
  • Phone: 813-374-2070
  • Fax: 813-337-0937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133001517
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: