Healthcare Provider Details

I. General information

NPI: 1104687920
Provider Name (Legal Business Name): JULISSA LLANOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 RICHMOND PKWY STE 600
RICHMOND TX
77469-3641
US

IV. Provider business mailing address

1803 RICHMOND PKWY STE 600
RICHMOND TX
77469-3641
US

V. Phone/Fax

Practice location:
  • Phone: 346-241-0137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-307741
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: