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General NPI Number Information
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NPI Number | 1023550621
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Entity Type | Individual
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Provider Name | ALEXANDER VIGOUREUX M.A., BCBA
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Gender | Male
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 11910 BOYETTE RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-5601
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Country | US
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Telephone | 813-374-2070
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Fax |
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Provider Business Mailing Address
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Address Line | 13645 LARAWAY DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-7137
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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