Healthcare Provider Details

I. General information

NPI: 1447609698
Provider Name (Legal Business Name): ALEXIS MONTERREY BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 EHRLICH RD STE 304
TAMPA FL
33624-2355
US

IV. Provider business mailing address

4606 KILCOYNE CT
LUTZ FL
33558-8035
US

V. Phone/Fax

Practice location:
  • Phone: 561-592-5290
  • Fax:
Mailing address:
  • Phone: 561-592-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberBCABA-0-17-8438
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-22-62643
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: