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NPI Code Detail

MEDICARE: ROSALYN PACE RBT

MEDICARE: ROSALYN PACE 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
1106S00000XBehavior Technician18-55823TX

General Provider Information

NPI Number : 1942775804
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSALYN PACE RBT
Provider Business Mailing Address
First Line : 7A 3RD ST W
Second Line :
City : UNIVERSAL CITY
State : TX
Zip : 78148-5653
Country : US
Telephone Number : 210-276-1786
Fax Number :
Provider Business Practice Location Address
First Line : 7608 NARROW PASS ST
Second Line :
City : LIVE OAK
State : TX
Zip : 78233-3019
Country : US
Telephone Number : 210-714-3545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2018
Last Update Date : 10/08/2018

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Directions to “ ROSALYN PACE RBT” Practice Location

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