Provider Demographics
NPI:1447912811
Name:ALCOCER, BRYAN EDUARDO
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:EDUARDO
Last Name:ALCOCER
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 1:210 A ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-3502
Mailing Address - Country:US
Mailing Address - Phone:298-354-9417
Mailing Address - Fax:
Practice Address - Street 1:1802 N IMPERIAL AVE STE D130
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-1325
Practice Address - Country:US
Practice Address - Phone:760-693-7617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst