Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003424938 |
---|---|
Provider Name | Luis Lopez |
First Address | Las Vegas, NV 89120-6293 |
Second Address | Las Vegas, NV 89120-6293 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2020 |
Last Update Date | 16/07/2020 |