MEDICARE: ANGIE PASCUAL NAZARETH PASCUAL MEDINA

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

General Provider Information

NPI Number	:	1376392076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGIE PASCUAL NAZARETH PASCUAL MEDINA

Provider Business Mailing Address
First Line	:	101 W CENTRAL TEXAS EXPY STE 101
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1704
Country	:	US
Telephone Number	:	786-372-2481
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W CENTRAL TEXAS EXPY STE 101
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1704
Country	:	US
Telephone Number	:	205-862-1707
Fax Number	:

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

Provider Enumeration Date	:	05/15/2024
Last Update Date	:	09/16/2025

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