Healthcare Provider Details

I. General information

NPI: 1568960243
Provider Name (Legal Business Name): MARINO PASCUAL JR. BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 04/01/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 ABRAMS RD STE 112
DALLAS TX
75214-2000
US

IV. Provider business mailing address

8179 MIDTOWN BLVD APT 6105
DALLAS TX
75231-4597
US

V. Phone/Fax

Practice location:
  • Phone: 469-906-6372
  • Fax:
Mailing address:
  • Phone: 559-269-5342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-44475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: