Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1356603039 |
---|---|
Provider Name | Carlos Eduardo Perez |
First Address | Sparks, NV 89431-6435 |
Second Address | Sparks, NV 89431-6435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2012 |
Last Update Date | 08/06/2012 |