Provider Demographics
NPI:1790647212
Name:BOURASSEAU, ALEXANDRE
Entity type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:
Last Name:BOURASSEAU
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 1:720 EDGEMAR AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2319
Mailing Address - Country:US
Mailing Address - Phone:650-400-1642
Mailing Address - Fax:
Practice Address - Street 1:2880 COCHRAN ST # 1001
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-0700
Practice Address - Country:US
Practice Address - Phone:626-720-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty