MEDICARE: KATHY ALVEAR BCBA

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	103K00000X	Behavior Analyst	1-04-1976	CA

General Provider Information

NPI Number	:	1649706946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY ALVEAR BCBA

Provider Business Mailing Address
First Line	:	612 REYNOLDS LN
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-4753
Country	:	US
Telephone Number	:	973-819-9975
Fax Number	:

Provider Business Practice Location Address
First Line	:	612 REYNOLDS LN
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-4753
Country	:	US
Telephone Number	:	973-819-9975
Fax Number	:

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

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	05/04/2017

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