Provider Demographics
NPI:1982484275
Name:BAEZA, AUSTIN ANDREW (RBT-23-301445)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:ANDREW
Last Name:BAEZA
Suffix:
Gender:M
Credentials:RBT-23-301445
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 CARSON HL STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-5500
Mailing Address - Country:US
Mailing Address - Phone:210-634-1129
Mailing Address - Fax:
Practice Address - Street 1:419 CARSON HL STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-5500
Practice Address - Country:US
Practice Address - Phone:210-634-1129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-301445106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician