Provider Demographics
NPI:1023648573
Name:BASCON, ALEJANDRO R (RADT I)
Entity type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:R
Last Name:BASCON
Suffix:
Gender:M
Credentials:RADT I
Other - Prefix:MR
Other - First Name:ALEJANDRO
Other - Middle Name:R
Other - Last Name:BASCON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUDC
Mailing Address - Street 1:2625 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-5201
Mailing Address - Country:US
Mailing Address - Phone:619-446-8507
Mailing Address - Fax:
Practice Address - Street 1:2625 E 14TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-5201
Practice Address - Country:US
Practice Address - Phone:619-446-8507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABV3647956101YA0400X
CAR1379800320101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)