Healthcare Provider Details

I. General information

NPI: 1538013123
Provider Name (Legal Business Name): XAVIER ANTONIO LOPEZ TEXIDOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 13TH ST
SAINT CLOUD FL
34769-4119
US

IV. Provider business mailing address

5616 MADDIE DR
HAINES CITY FL
33844-6553
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-4885
  • Fax:
Mailing address:
  • Phone: 787-901-6087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: