MEDICARE: DASIA MICHELLE BAZALDUA

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
1	103K00000X	Behavior Analyst	1440002	TX

General Provider Information

NPI Number	:	1194659912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DASIA MICHELLE BAZALDUA

Provider Business Mailing Address
First Line	:	23106 BAYLEAF DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-6486
Country	:	US
Telephone Number	:	210-447-0039
Fax Number	:

Provider Business Practice Location Address
First Line	:	21755 I45 N
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-3607
Country	:	US
Telephone Number	:	210-447-0039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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Directions to “ DASIA MICHELLE BAZALDUA ” Practice Location

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