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General NPI Number Information
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NPI Number | 1922750884
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Entity Type | Individual
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Provider Name | EZEQUIEL ENRIQUE ACEVEDO
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Gender | Male
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 7400 BLANCO RD STE 115
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City | SAN ANTONIO
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State | TX
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Zip | 78216-4361
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Country | US
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Telephone | 210-657-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 715 SPACIOUS SKY
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City | SAN ANTONIO
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State | TX
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Zip | 78260-6428
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Country | US
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Telephone | 847-691-0446
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BCBA-25-3286-625719
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License Number State | TX
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