Provider Demographics
NPI:1669003158
Name:ALEJANDRO, MARCO ANTONIO II (AMFT#106606)
Entity type:Individual
Prefix:MR
First Name:MARCO
Middle Name:ANTONIO
Last Name:ALEJANDRO
Suffix:II
Gender:M
Credentials:AMFT#106606
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 EL CAMINO REAL SCU-3097
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95053-3097
Mailing Address - Country:US
Mailing Address - Phone:408-250-7868
Mailing Address - Fax:
Practice Address - Street 1:197 E HAMILTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0261
Practice Address - Country:US
Practice Address - Phone:408-679-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106606106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106606OtherAETNA
CA106606OtherBLUE SHIELD
CA106606OtherBLUE CROSS
CA106606OtherKAISER-PERMANENTE