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General NPI Number Information
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NPI Number | 1902497290
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Entity Type | Individual
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Provider Name | ABIGAIL MATA CASTILLO
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Gender | Female
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Dates
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Enumeration Date | 01/29/2021
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 15140 BADGER RANCH BLVD STE 301 & 302
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City | WOODWAY
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State | TX
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Zip | 76712
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Country | US
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Telephone | 254-829-4787
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Fax |
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Provider Business Mailing Address
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Address Line | 1404 W 11TH ST
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City | MCGREGOR
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State | TX
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Zip | 76657-1937
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Country | US
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Telephone | 254-420-9074
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT21150488
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License Number State | TX
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