Provider Demographics
NPI:1700434339
Name:MOTA, ALEX ALBERTO
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:ALBERTO
Last Name:MOTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1404
Mailing Address - Country:US
Mailing Address - Phone:626-320-1317
Mailing Address - Fax:626-251-4266
Practice Address - Street 1:222 E LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1404
Practice Address - Country:US
Practice Address - Phone:626-320-1317
Practice Address - Fax:626-251-4266
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-19-9805103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0-19-9805OtherBEHAVIOR ANALYST CERTIFICATION BOARD