Healthcare Provider Details

I. General information

NPI: 1194659912
Provider Name (Legal Business Name): DASIA MICHELLE BAZALDUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21755 I45 N
SPRING TX
77388-3607
US

IV. Provider business mailing address

23106 BAYLEAF DR
SPRING TX
77373-6486
US

V. Phone/Fax

Practice location:
  • Phone: 210-447-0039
  • Fax:
Mailing address:
  • Phone: 210-447-0039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1440002
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: