MEDICARE: MISS ANGELA MARIE DUPUY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1104186238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANGELA MARIE DUPUY

Provider Business Mailing Address
First Line	:	2121 N.JONES 247#
Second Line	:	247#
City	:	LAS VEGAS
State	:	NV
Zip	:	89108
Country	:	US
Telephone Number	:	702-353-8128
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 N JONES BLVD
Second Line	:	247#
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-3300
Country	:	US
Telephone Number	:	702-353-8128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2012
Last Update Date	:	05/11/2026

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