Healthcare Provider Details

I. General information

NPI: 1720966500
Provider Name (Legal Business Name): SABBETAI N/A HURTADO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 COLE AVE STE 600
DALLAS TX
75205-4193
US

IV. Provider business mailing address

4825 FALLS ST # A
HOUSTON TX
77026-2632
US

V. Phone/Fax

Practice location:
  • Phone: 800-883-8441
  • Fax:
Mailing address:
  • Phone: 281-875-5186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1322840
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: