=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083481055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LATINA PHD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2023
-----------------------------------------------------
Last Update Date | 02/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13800 LYNDHURST ST UNIT 52
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78717-6063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-804-8798
-----------------------------------------------------
Fax | 737-309-3719
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13800 LYNDHURST ST UNIT 52
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78717-6063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 737-309-3719
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | SUSANNE ALBARRAN
-----------------------------------------------------
Credential | PHD, BCBA, LBA-TX
-----------------------------------------------------
Telephone | 512-804-8798
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------