Healthcare Provider Details

I. General information

NPI: 1962306118
Provider Name (Legal Business Name): ALYSSA CARRAZCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 AMERICAN PACIFIC DR
HENDERSON NV
89014-8800
US

IV. Provider business mailing address

874 AMERICAN PACIFIC DR
HENDERSON NV
89014-8800
US

V. Phone/Fax

Practice location:
  • Phone: 702-777-4808
  • Fax: 702-777-4818
Mailing address:
  • Phone: 702-777-4808
  • Fax: 702-777-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number2843021
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: