Provider Demographics
NPI:1164181236
Name:DUARTE MARTINEZ, ALFREDO (BCBA)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:DUARTE MARTINEZ
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 S 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-2308
Mailing Address - Country:US
Mailing Address - Phone:408-841-1593
Mailing Address - Fax:
Practice Address - Street 1:315 LOS GATOS SARATOGA RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5310
Practice Address - Country:US
Practice Address - Phone:408-649-7349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-51646103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty