Provider Demographics
NPI:1265268817
Name:FERNANDEZ DURAN, CARLOS YUMEL
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:YUMEL
Last Name:FERNANDEZ DURAN
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 1:6636 ARGONNE DR APT 9302
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-2579
Mailing Address - Country:US
Mailing Address - Phone:979-291-9202
Mailing Address - Fax:
Practice Address - Street 1:13625 BEECHNUT ST STE U
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6843
Practice Address - Country:US
Practice Address - Phone:281-845-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-350316106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician