Healthcare Provider Details

I. General information

NPI: 1679110340
Provider Name (Legal Business Name): GIOMAR STANLEY SAJCHE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 PREMIER DR STE 234
IRVING TX
75063-2693
US

IV. Provider business mailing address

3100 PREMIER DR STE 234
IRVING TX
75063-2693
US

V. Phone/Fax

Practice location:
  • Phone: 972-756-1222
  • Fax:
Mailing address:
  • Phone: 214-918-7563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-107398
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: