Healthcare Provider Details

I. General information

NPI: 1285520809
Provider Name (Legal Business Name): MARIANA HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VALLEY WOOD DR STE B200
THE WOODLANDS TX
77380-5408
US

IV. Provider business mailing address

PO BOX 151716
AUSTIN TX
78715-1716
US

V. Phone/Fax

Practice location:
  • Phone: 512-898-9044
  • Fax: 512-857-1423
Mailing address:
  • Phone: 512-898-9044
  • Fax: 512-857-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-316552
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: