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NPI Code Detail

MEDICARE: HANNAH BURGOS

MEDICARE: HANNAH BURGOS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-19-77221TX

General Provider Information

NPI Number : 1053876482
Entity Type Code : Individual
Provider Name (Legal Business Name) : HANNAH BURGOS
Provider Business Mailing Address
First Line : 2425 E SOUTHLAKE BLVD STE 100
Second Line :
City : SOUTHLAKE
State : TX
Zip : 76092-6675
Country : US
Telephone Number : 817-442-0222
Fax Number : 817-442-0223
Provider Business Practice Location Address
First Line : 1652 KELLER PKWY STE 200
Second Line :
City : KELLER
State : TX
Zip : 76248-3877
Country : US
Telephone Number : 682-291-9910
Fax Number : 817-977-4671
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2019
Last Update Date : 02/11/2021

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Directions to “ HANNAH BURGOS ” Practice Location

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