Provider Demographics
NPI:1396217873
Name:GARCIA, ALEXA MORALES
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:MORALES
Last Name:GARCIA
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 1:910 W SAN MARCOS BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1116
Mailing Address - Country:US
Mailing Address - Phone:619-847-9153
Mailing Address - Fax:
Practice Address - Street 1:910 W SAN MARCOS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1116
Practice Address - Country:US
Practice Address - Phone:619-847-9153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-18-72186106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARBT-18-72186OtherREGISTERED BEHAVIOR TECHNICIAN