Provider Demographics
NPI:1043711195
Name:MONTOYA VILLALPANDO, ALEXIS (MS PSYCHOLOGY)
Entity Type:Individual
Prefix:MR
First Name:ALEXIS
Middle Name:
Last Name:MONTOYA VILLALPANDO
Suffix:
Gender:M
Credentials:MS PSYCHOLOGY
Other - Prefix:MR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS PSYCHOLOGY
Mailing Address - Street 1:2885 PIXIE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203-1115
Mailing Address - Country:US
Mailing Address - Phone:209-235-7068
Mailing Address - Fax:
Practice Address - Street 1:1141 LEVER BLVD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-2855
Practice Address - Country:US
Practice Address - Phone:209-872-6091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-51181103K00000X, 103K00000X
CARBT-18-52065106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician