MEDICARE: MARIELA CONTRERAS

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-21-170456	TX

General Provider Information

NPI Number	:	1649842485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIELA CONTRERAS

Provider Business Mailing Address
First Line	:	1799 KIRBY DR STE 110
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5624
Country	:	US
Telephone Number	:	281-407-5559
Fax Number	:

Provider Business Practice Location Address
First Line	:	1799 KIRBY DR STE 110
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5624
Country	:	US
Telephone Number	:	281-407-5559
Fax Number	:

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

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	07/12/2021

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Directions to “ MARIELA CONTRERAS ” Practice Location

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