Healthcare Provider Details

I. General information

NPI: 1447140348
Provider Name (Legal Business Name): YESENIA WUITRON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 WINDCOM CT STE 400
PLANO TX
75093-9003
US

IV. Provider business mailing address

2250 E PROSPER TRL BLDG B
PROSPER TX
75078-2785
US

V. Phone/Fax

Practice location:
  • Phone: 972-388-4779
  • Fax: 972-312-8733
Mailing address:
  • Phone: 972-312-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-340018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: