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NPI Code Detail

MEDICARE: BLAINE SENIOR

MEDICARE: BLAINE SENIOR
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
1103K00000XBehavior AnalystNV

General Provider Information

NPI Number : 1194143354
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAINE SENIOR
Provider Business Mailing Address
First Line : 3636 LAS VEGAS BLVD N STE B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-1556
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3636 LAS VEGAS BLVD N STE B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-1556
Country : US
Telephone Number : 702-776-8397
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2014
Last Update Date : 04/03/2014

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Directions to “ BLAINE SENIOR ” Practice Location

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