Provider Demographics
NPI:1043008295
Name:HAGEL, ALICIA JUSTINE
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:JUSTINE
Last Name:HAGEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:JUSTINE
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1628 CARMEL CIR W
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1714
Mailing Address - Country:US
Mailing Address - Phone:909-636-3513
Mailing Address - Fax:
Practice Address - Street 1:1628 CARMEL CIR W
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-1714
Practice Address - Country:US
Practice Address - Phone:909-636-3513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-25-79200103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst