Healthcare Provider Details

I. General information

NPI: 1679499255
Provider Name (Legal Business Name): YADANIS GONZALEZ MACIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 SPEARMINT ST
BALCH SPRINGS TX
75181-4453
US

IV. Provider business mailing address

118 SPEARMINT ST
BALCH SPRINGS TX
75181-4453
US

V. Phone/Fax

Practice location:
  • Phone: 832-960-1682
  • Fax:
Mailing address:
  • Phone: 832-960-1682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: