Healthcare Provider Details

I. General information

NPI: 1275453417
Provider Name (Legal Business Name): GLADYS CAROLINA RUBALCAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W WALL ST
GRAPEVINE TX
76051-5285
US

IV. Provider business mailing address

2541 BUTTONBUSH LN
GARLAND TX
75042-4063
US

V. Phone/Fax

Practice location:
  • Phone: 817-442-7086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25457753
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: