MEDICARE: DANIEL NUGROHO

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	106S00000X	Behavior Technician	RBT-26-511070	TX

General Provider Information

NPI Number	:	1366374605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL NUGROHO

Provider Business Mailing Address
First Line	:	9310 PECOS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-4410
Country	:	US
Telephone Number	:	281-752-0403
Fax Number	:

Provider Business Practice Location Address
First Line	:	14058 MEMORIAL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-6848
Country	:	US
Telephone Number	:	281-752-0403
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ DANIEL NUGROHO ” Practice Location

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