MEDICARE: LIZETH CHAVEZ HURTADO RBT

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	:	1457182156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZETH CHAVEZ HURTADO RBT

Provider Business Mailing Address
First Line	:	12175 NETWORK BLVD STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3432
Country	:	US
Telephone Number	:	210-797-7181
Fax Number	:

Provider Business Practice Location Address
First Line	:	15656 CLASSEN RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-2184
Country	:	US
Telephone Number	:	210-797-7181
Fax Number	:

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

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	08/13/2024

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