MEDICARE: VALENCIA AMOS

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	:	1558837401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALENCIA AMOS

Provider Business Mailing Address
First Line	:	5600 E RUSSELL RD UNIT 2414
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-8017
Country	:	US
Telephone Number	:	702-769-1277
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 E RUSSELL RD UNIT 2414
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-8017
Country	:	US
Telephone Number	:	702-769-1277
Fax Number	:

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

Provider Enumeration Date	:	10/18/2018
Last Update Date	:	10/18/2018

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Directions to “ VALENCIA AMOS ” Practice Location

Language	Start Address	Practice Location

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