Healthcare Provider Details

I. General information

NPI: 1073123147
Provider Name (Legal Business Name): BEATRIZ ADRIANA FERNANDEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8408 STACY RD STE 300
MCKINNEY TX
75070-2422
US

IV. Provider business mailing address

238 COUNTY ROAD 911
ROYSE CITY TX
75189-7283
US

V. Phone/Fax

Practice location:
  • Phone: 469-625-2193
  • Fax: 469-998-2193
Mailing address:
  • Phone: 469-625-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-91463
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: