Healthcare Provider Details

I. General information

NPI: 1336029677
Provider Name (Legal Business Name): LAS RAICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10738 N 184TH DR
SURPRISE AZ
85388-2308
US

IV. Provider business mailing address

10738 N 184TH DR
SURPRISE AZ
85388-2308
US

V. Phone/Fax

Practice location:
  • Phone: 602-209-4965
  • Fax: 386-703-1162
Mailing address:
  • Phone: 602-209-4965
  • Fax: 386-703-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAULINE CRYSTAL BROWN
Title or Position: BCBA
Credential:
Phone: 480-865-9506