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General NPI Number Information
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NPI Number | 1790647212
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Entity Type | Individual
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Provider Name | ALEXANDRE BOURASSEAU
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Gender | Male
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 2880 COCHRAN ST # 1001
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City | SIMI VALLEY
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State | CA
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Zip | 93065-0700
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Country | US
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Telephone | 626-720-7266
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Fax |
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Provider Business Mailing Address
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Address Line | 720 EDGEMAR AVE
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City | PACIFICA
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State | CA
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Zip | 94044-2319
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Country | US
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Telephone | 650-400-1642
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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