Healthcare Provider Details

I. General information

NPI: 1902116510
Provider Name (Legal Business Name): VICTOR G ITURRIOS MFT-INTERN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S JONES BLVD
LAS VEGAS NV
89146-1260
US

IV. Provider business mailing address

2655 ENTERPRISE RD
RENO NV
89512-1666
US

V. Phone/Fax

Practice location:
  • Phone: 702-275-6915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI4450
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: