Basic Information
| Provider Information | |||||||||
| NPI: | 1861937245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAEZ PINEDA | ||||||||
| FirstName: | LUISA | ||||||||
| MiddleName: | FERNANDA | ||||||||
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| Credential: | MSC, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2831 ELDORADO PKWY STE 103-187 | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750337438 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 E ROYAL LN BLDG 3 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750393540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558326727 | ||||||||
| FaxNumber: | 7726759100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2016 | ||||||||
| LastUpdateDate: | 03/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-16-24962 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.