Healthcare Provider Details

I. General information

NPI: 1366361875
Provider Name (Legal Business Name): MIYA MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINTHE MORALES

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9089 S PECOS RD
HENDERSON NV
89074-7183
US

IV. Provider business mailing address

9089 S PECOS RD
HENDERSON NV
89074-7183
US

V. Phone/Fax

Practice location:
  • Phone: 702-680-1526
  • Fax:
Mailing address:
  • Phone: 702-680-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT6634
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: