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General NPI Number Information
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NPI Number | 1356038269
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Entity Type | Individual
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Provider Name | ALISA MOODY
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Gender | Female
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Dates
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Enumeration Date | 04/20/2023
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 500 S CHESTER AVE
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City | COMPTON
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State | CA
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Zip | 90221-3902
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Country | US
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Telephone | 951-375-6345
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Fax |
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Provider Business Mailing Address
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Address Line | 713 W COMMONWEALTH AVE
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City | FULLERTON
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State | CA
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Zip | 92832-1612
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Country | US
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Telephone | 657-799-3152
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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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Taxonomy #2
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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