=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316486749
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEUROHISPANOS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2017
-----------------------------------------------------
Last Update Date | 05/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1404 GABLES CT STE 102
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-548-4803
-----------------------------------------------------
Fax | 888-974-0364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 N. CENTRAL EXPRESSWAY PMB 1482
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75070-7647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-548-4803
-----------------------------------------------------
Fax | 888-974-0364
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATRINA BELEN
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 786-315-6655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------