Provider Demographics
NPI:1609633601
Name:ALCANTARA, LYNELLE ROSE
Entity Type:Individual
Prefix:
First Name:LYNELLE
Middle Name:ROSE
Last Name:ALCANTARA
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 1:13558 VAN HORN CIR W
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4861
Mailing Address - Country:US
Mailing Address - Phone:909-576-1012
Mailing Address - Fax:
Practice Address - Street 1:13558 VAN HORN CIR W
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4861
Practice Address - Country:US
Practice Address - Phone:909-576-1012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician