MEDICARE: STEPHANIE ALEXA BETANCOURT

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	106E00000X	Assistant Behavior Analyst	RBT-25-404552	CA
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1841054178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ALEXA BETANCOURT

Provider Business Mailing Address
First Line	:	4221 WILSHIRE BLVD STE 300A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3537
Country	:	US
Telephone Number	:	888-428-3223
Fax Number	:	323-866-1881

Provider Business Practice Location Address
First Line	:	1311 PARK ST # 1099
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4507
Country	:	US
Telephone Number	:	888-428-3223
Fax Number	:

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

Provider Enumeration Date	:	02/07/2024
Last Update Date	:	07/10/2025

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