Provider Demographics
NPI:1710488622
Name:ALEGRE, MIGUEL (MED)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:ALEGRE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 MOUNTAIN VIEW ST APT 198
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-6555
Mailing Address - Country:US
Mailing Address - Phone:661-333-7721
Mailing Address - Fax:
Practice Address - Street 1:5558 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0705
Practice Address - Country:US
Practice Address - Phone:661-326-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CA1-19-35049103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist