Healthcare Provider Details

I. General information

NPI: 1235885005
Provider Name (Legal Business Name): AYAKA FREDRICKA MERINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N STEPHANIE ST STE 1514
HENDERSON NV
89014-8902
US

IV. Provider business mailing address

375 N STEPHANIE ST STE 1514
HENDERSON NV
89014-8902
US

V. Phone/Fax

Practice location:
  • Phone: 702-550-2791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0770
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: