=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447026794
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDRA NEGULESCU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2023
-----------------------------------------------------
Last Update Date | 09/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1175 ADKINS RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77055-7413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-391-8688
-----------------------------------------------------
Fax | 866-936-4614
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 919 GILLETTE ST APT 4089
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77019-2749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-620-6605
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------