Provider Demographics
NPI:1083179022
Name:ANGUIANO, ALEJANDRA NATALIE
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:NATALIE
Last Name:ANGUIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18117 BANDY CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3713
Mailing Address - Country:US
Mailing Address - Phone:760-532-8782
Mailing Address - Fax:
Practice Address - Street 1:16885 VIA DEL CAMPO CT STE 314
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1753
Practice Address - Country:US
Practice Address - Phone:858-987-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician