Healthcare Provider Details

I. General information

NPI: 1639034903
Provider Name (Legal Business Name): DE'RICHARD RAYFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9089 S PECOS RD SUITE 3400
HENDERSON NV
89074
US

IV. Provider business mailing address

6570 TUMBLEWEED RIDGE LN UNIT 101
HENDERSON NV
89011
US

V. Phone/Fax

Practice location:
  • Phone: 702-867-5810
  • Fax:
Mailing address:
  • Phone: 909-561-0963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-358884
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: