Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-17-41330 | NV |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1013356906 |
---|---|
Provider Name | Agustin Pena |
First Address | Las Vegas, NV 89101-3401 |
Second Address | Las Vegas, NV 89101-3401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2013 |
Last Update Date | 02/03/2018 |