Healthcare Provider Details

I. General information

NPI: 1295075083
Provider Name (Legal Business Name): JOSH BJORK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N BUFFALO DR 213
LAS VEGAS NV
89128-0379
US

IV. Provider business mailing address

911 N BUFFALO DR 213
LAS VEGAS NV
89128-0379
US

V. Phone/Fax

Practice location:
  • Phone: 702-942-1774
  • Fax: 702-942-1773
Mailing address:
  • Phone: 702-942-1774
  • Fax: 702-942-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: