MEDICARE: ALEXANDRA ELIZABETH IRIARTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1235094004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA ELIZABETH IRIARTE

Provider Business Mailing Address
First Line	:	28 S 10TH ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-3501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 MERIDIAN AVE # 302
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5350
Country	:	US
Telephone Number	:	831-682-8750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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