Provider Demographics
NPI:1548036395
Name:ESPINOZA, ALEXANDRA DESIREE (BS, RBT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DESIREE
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:BS, RBT
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:DESIREE
Other - Last Name:MORUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27777 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5310
Mailing Address - Country:US
Mailing Address - Phone:248-256-2050
Mailing Address - Fax:
Practice Address - Street 1:27777 INKSTER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5310
Practice Address - Country:US
Practice Address - Phone:248-256-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
AZRBT-23-302513106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician