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NPI Code Detail

MEDICARE: MARIEL CREMONIE FERNANDEZ BCBA

MEDICARE: MARIEL CREMONIE FERNANDEZ BCBA
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
1103K00000XBehavior Analyst1-04-2082TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-04-2082OTHERBCBA
21-04-2082OTHERTXMS, BCBA

General Provider Information

NPI Number : 1528363421
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIEL CREMONIE FERNANDEZ BCBA
Provider Business Mailing Address
First Line : 10503 METRIC DRIVE
Second Line :
City : DALLAS
State : TX
Zip : 75243
Country : US
Telephone Number : 972-644-2076
Fax Number : 972-644-5650
Provider Business Practice Location Address
First Line : 10503 METRIC DR
Second Line :
City : DALLAS
State : TX
Zip : 75243-5514
Country : US
Telephone Number : 972-644-2076
Fax Number : 972-644-5650
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2011
Last Update Date : 05/27/2015

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