MEDICARE: JAVIER CALZADILLA JR. MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	1-22-61781	TX

General Provider Information

NPI Number	:	1083130215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER CALZADILLA JR. MS

Provider Business Mailing Address
First Line	:	7500 SAN FELIPE ST STE 990
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-1708
Country	:	US
Telephone Number	:	915-320-4710
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 HAWKINS BLVD STE 100
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1201
Country	:	US
Telephone Number	:	915-320-4710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2017
Last Update Date	:	11/21/2022

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