Healthcare Provider Details

I. General information

NPI: 1124943808
Provider Name (Legal Business Name): YAJAIRA CARLOS ALEJO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 1ST AVE NE
AUSTIN MN
55912-4502
US

IV. Provider business mailing address

818 NORTH BLVD
OAK PARK IL
60301-1302
US

V. Phone/Fax

Practice location:
  • Phone: 866-756-0128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: