Most Relevant Information
Provider Data
| NPI Number: | 1003671389 |
| Provider Name: | FRED BANUELOS |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/16/2024 |
| Last Updated: | 02/16/2024 |
Provider Practice Location
1250 S A W GRIMES BLVD
ROUND ROCK
TX
786642854
Practice Location Phone/Fax
| Phone: | 5126614387 |
| Fax: |
Provider Mailing Location
2701 BREEZY POINT CV
ROUND ROCK
TX
786652590
Provider Mailing Phone/Fax
| Phone: | 5122998224 |
| Fax: |