Provider Demographics
NPI:1154083814
Name:MATAMOROS MENDOZA, VALERIA ROCIO (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:ROCIO
Last Name:MATAMOROS MENDOZA
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:VALERIA
Other - Middle Name:ROCICO
Other - Last Name:MATAMOROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, BCBA
Mailing Address - Street 1:2100 KRAMER LN STE 150
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4096
Mailing Address - Country:US
Mailing Address - Phone:512-575-0157
Mailing Address - Fax:
Practice Address - Street 1:2100 KRAMER LN STE 150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4096
Practice Address - Country:US
Practice Address - Phone:512-572-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB524805103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst