MEDICARE: MEBE TEXAS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	225X00000X	Occupational Therapist
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1548883317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEBE TEXAS, LLC

Provider Business Mailing Address
First Line	:	8885 RIO SAN DIEGO DR STE 340
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1669
Country	:	US
Telephone Number	:	619-975-9925
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 LAVACA ST # 742
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1634
Country	:	US
Telephone Number	:	619-795-9925
Fax Number	:

Authorized Official
Title or Position	:	CONTRACTS/CREDENTIALING SPECIALIST
Name	:	MR. ESTEBAN GONZALEZ
Credential	:
Telephone Number	:	619-323-0832

Provider Enumeration Date	:	05/27/2020
Last Update Date	:	07/02/2020

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Directions to “MEBE TEXAS, LLC ” Practice Location

Language	Start Address	Practice Location

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