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NPI Code Detail

MEDICARE: IVAN ALEXANDER BUENROSTRO HERNANDEZ

MEDICARE: IVAN ALEXANDER BUENROSTRO HERNANDEZ
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
1106S00000XBehavior TechnicianRBT5566NV

General Provider Information

NPI Number : 1346191442
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVAN ALEXANDER BUENROSTRO HERNANDEZ
Provider Business Mailing Address
First Line : 9167 W FLAMINGO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6472
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9167 W FLAMINGO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6472
Country : US
Telephone Number : 702-565-1894
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2026
Last Update Date : 02/04/2026

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Directions to “ IVAN ALEXANDER BUENROSTRO HERNANDEZ ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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