MEDICARE: KIMBERLY COBOS RBT

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	106S00000X	Behavior Technician	RBT1023	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-19-102654	OTHER		BEHAVIOR ANALYST CERTIFICATION BOARD
2	RBT1023	OTHER	NV	NEVADA AGING AND DISABILITY SERVICES

General Provider Information

NPI Number	:	1700424348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY COBOS RBT

Provider Business Mailing Address
First Line	:	1825 CAMINO MIRADA
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1093
Country	:	US
Telephone Number	:	702-287-6872
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 W ANN RD STE 120
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4407
Country	:	US
Telephone Number	:	702-323-6555
Fax Number	:

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

Provider Enumeration Date	:	12/13/2019
Last Update Date	:	12/13/2019

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Directions to “ KIMBERLY COBOS RBT” Practice Location

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