Individual
STEPHANIE REALIVASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1228 E EXCHANGE PKWY STE 118, ALLEN, TX 75002-1980
(214) 284-0677
Mailing address
1228 E EXCHANGE PKWY STE 118, ALLEN, TX 75002-1980
(214) 284-0677
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
310995
TX
Other
Enumeration date
03/09/2023
Last updated
03/09/2023
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