Provider Demographics
NPI:1508585944
Name:CARBAJAL, ANDRES
Entity Type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:
Last Name:CARBAJAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 DORRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3209
Mailing Address - Country:US
Mailing Address - Phone:346-388-1088
Mailing Address - Fax:
Practice Address - Street 1:2223 DORRINGTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3209
Practice Address - Country:US
Practice Address - Phone:346-388-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician