MEDICARE: MR. ALAN PETALVER ALMOGELA

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	1837	TX

General Provider Information

NPI Number	:	1669970356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALAN PETALVER ALMOGELA

Provider Business Mailing Address
First Line	:	PO BOX 33568
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92163-3568
Country	:	US
Telephone Number	:	855-223-7123
Fax Number	:	619-374-7134

Provider Business Practice Location Address
First Line	:	1101 W 40TH ST STE 10
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3609
Country	:	US
Telephone Number	:	855-223-7123
Fax Number	:	619-374-7134

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

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	05/06/2023

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