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NPI Code Detail

MEDICARE: BOUSSO DIOP

MEDICARE: BOUSSO DIOP
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-24-380996TX

General Provider Information

NPI Number : 1063232072
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOUSSO DIOP
Provider Business Mailing Address
First Line : 2520 HEATHER BROOK LN APT 807
Second Line :
City : ARLINGTON
State : TX
Zip : 76006-5177
Country : US
Telephone Number : 469-494-2908
Fax Number :
Provider Business Practice Location Address
First Line : 2655 VILLA CREEK DR STE 140
Second Line :
City : FARMERS BRANCH
State : TX
Zip : 75234-7385
Country : US
Telephone Number : 214-736-8376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2024
Last Update Date : 10/14/2024

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Directions to “ BOUSSO DIOP ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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