Provider Demographics
NPI:1215630546
Name:VARNADO, ALPHONCE III
Entity type:Individual
Prefix:
First Name:ALPHONCE
Middle Name:
Last Name:VARNADO
Suffix:III
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 1:12230 WESTERLY TRL
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-7524
Mailing Address - Country:US
Mailing Address - Phone:951-269-8493
Mailing Address - Fax:
Practice Address - Street 1:12230 WESTERLY TRL
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7524
Practice Address - Country:US
Practice Address - Phone:951-269-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst