Provider Demographics
NPI:1689477242
Name:FOVOS, ALEXIS C
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:C
Last Name:FOVOS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 SANDPIPER LN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1840
Mailing Address - Country:US
Mailing Address - Phone:949-636-9073
Mailing Address - Fax:
Practice Address - Street 1:173 SANDPIPER LN
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-1840
Practice Address - Country:US
Practice Address - Phone:949-636-9073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician