Provider Demographics
NPI:1699414128
Name:LEGANOA, ALEXANDER SR (CBHCM-P)
Entity Type:Individual
Prefix:PROF
First Name:ALEXANDER
Middle Name:
Last Name:LEGANOA
Suffix:SR
Gender:M
Credentials:CBHCM-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5590 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-7070
Mailing Address - Country:US
Mailing Address - Phone:786-972-8466
Mailing Address - Fax:305-825-8117
Practice Address - Street 1:5590 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-7070
Practice Address - Country:US
Practice Address - Phone:305-825-4320
Practice Address - Fax:305-825-8117
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0104836-P171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator