Healthcare Provider Details

I. General information

NPI: 1023946761
Provider Name (Legal Business Name): SERGIO SALAZAR-VILLANUEVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PRECISION # A100A300
BUDA TX
78610-5925
US

IV. Provider business mailing address

211 AMES CV
KYLE TX
78640-2505
US

V. Phone/Fax

Practice location:
  • Phone: 512-628-7690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number10258
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: