MEDICARE: DEREK MANUEL OJEDA GUTIERREZ

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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1669318119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK MANUEL OJEDA GUTIERREZ

Provider Business Mailing Address
First Line	:	2100 GEORGE DIETER DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-3815
Country	:	US
Telephone Number	:	915-999-6950
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 GEORGE DIETER DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-3815
Country	:	US
Telephone Number	:	915-999-6950
Fax Number	:

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

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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