MEDICARE: MADISON ARRAEZ

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
2	103K00000X	Behavior Analyst	1-22-60766	TX

General Provider Information

NPI Number	:	1982343174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON ARRAEZ

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	:	619-795-9925
Fax Number	:	877-602-5087

Provider Business Practice Location Address
First Line	:	6319 CYPRESSWOOD DR STE 200
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-8208
Country	:	US
Telephone Number	:	619-795-9925
Fax Number	:

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

Provider Enumeration Date	:	06/03/2022
Last Update Date	:	09/02/2022

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Directions to “ MADISON ARRAEZ ” Practice Location

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