Active NPI
Fred Banuelos
- Behavior Technician
- Round Rock, TX
National Provider Identifier
1003671389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1250 S a W Grimes Blvd
Round Rock, TX 78664-2854 - Phone
- (512) 661-4387
- NPI assigned
- Feb 16, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | TX | Primary |
Addresses
Primary practice location
1250 S a W Grimes Blvd
Round Rock, TX 78664-2854
Mailing address
2701 Breezy Point CV
Round Rock, TX 78665-2590
Phone (512) 299-8224
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708041600000",
"number": "1003671389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2701 BREEZY POINT CV",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "786652590",
"telephone_number": "512-299-8224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 S A W GRIMES BLVD",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "786642854",
"telephone_number": "512-661-4387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANUELOS",
"first_name": "FRED",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-02-16",
"last_updated": "2024-02-16",
"certification_date": "2024-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "TX",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Round Rock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.