Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-21-56410 | TX |
N | 106S00000X | Behavior Technician |
NPI | 1003334731 |
---|---|
Provider Name | Roxana Lourdes Fernandez |
First Address | El Paso, TX 79907-5308 |
Second Address | El Paso, TX 79901-1443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2017 |
Last Update Date | 10/02/2022 |