MEDICARE: ANIBAL PEREZ MENDIOLA

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	106E00000X	Assistant Behavior Analyst
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1679934962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANIBAL PEREZ MENDIOLA

Provider Business Mailing Address
First Line	:	2304 BRISTOL BAY CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2930
Country	:	US
Telephone Number	:	702-330-6158
Fax Number	:

Provider Business Practice Location Address
First Line	:	2304 BRISTOL BAY CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2930
Country	:	US
Telephone Number	:	702-330-6158
Fax Number	:

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

Provider Enumeration Date	:	03/14/2016
Last Update Date	:	11/21/2025

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