Healthcare Provider Details

I. General information

NPI: 1467930693
Provider Name (Legal Business Name): DIANDRA MICHELLE MALDONADO M.ED. BCBA, LBA-TX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 10/13/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W SESAME DR
HARLINGEN TX
78550-7962
US

IV. Provider business mailing address

PO BOX 87
ALAMO TX
78516-0087
US

V. Phone/Fax

Practice location:
  • Phone: 956-230-1605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-160909
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number39629
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number5377
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: