Healthcare Provider Details

I. General information

NPI: 1740986561
Provider Name (Legal Business Name): MARIA FERNANDA LOPEZ SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 HILLSIDE DR
ROUND ROCK TX
78681-3742
US

IV. Provider business mailing address

8205 MILLER FALLS DR
ROUND ROCK TX
78681-3567
US

V. Phone/Fax

Practice location:
  • Phone: 512-677-9339
  • Fax:
Mailing address:
  • Phone: 617-756-8984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-248815
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-84209
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: