Provider Demographics
NPI:1831915057
Name:SURITA PABON, ERIC JAVIER
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JAVIER
Last Name:SURITA PABON
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 1:2409 WATERFALL DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5659
Mailing Address - Country:US
Mailing Address - Phone:910-299-8518
Mailing Address - Fax:
Practice Address - Street 1:310 W CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-2573
Practice Address - Country:US
Practice Address - Phone:254-833-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician