Provider Demographics
NPI:1376024265
Name:ALSTATT, EVGENIYA VARLAMOVA (RBT)
Entity Type:Individual
Prefix:DR
First Name:EVGENIYA
Middle Name:VARLAMOVA
Last Name:ALSTATT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:ALSTATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:26895 ALISO CREEK RD STE B
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5302
Mailing Address - Country:US
Mailing Address - Phone:816-797-6442
Mailing Address - Fax:
Practice Address - Street 1:13950 MILTON AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:816-797-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-58709106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty