MEDICARE: ROBERTO GENARO ALONSO BT

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		CA

General Provider Information

NPI Number	:	1770278434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO GENARO ALONSO BT

Provider Business Mailing Address
First Line	:	3842 VELMA AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-1820
Country	:	US
Telephone Number	:	626-329-8974
Fax Number	:

Provider Business Practice Location Address
First Line	:	3842 VELMA AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-1820
Country	:	US
Telephone Number	:	626-329-8974
Fax Number	:

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

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	04/10/2023

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