Healthcare Provider Details

I. General information

NPI: 1194031096
Provider Name (Legal Business Name): ALONZO ANDREWS BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10615 PERRIN BEITEL RD STE. 801
SAN ANTONIO TX
78217-3138
US

IV. Provider business mailing address

10615 PERRIN BEITEL RD STE. 801
SAN ANTONIO TX
78217-3138
US

V. Phone/Fax

Practice location:
  • Phone: 210-599-7733
  • Fax: 210-599-3105
Mailing address:
  • Phone: 210-599-7733
  • Fax: 210-599-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-6844
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: