Healthcare Provider Details

I. General information

NPI: 1518855691
Provider Name (Legal Business Name): CHIDOZIE ALEX OKOLI II RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 RENAISSANCE DR STE D
LAS VEGAS NV
89119-6758
US

IV. Provider business mailing address

7851 TORREYS PEAK ST
LAS VEGAS NV
89166-5076
US

V. Phone/Fax

Practice location:
  • Phone: 702-763-5379
  • Fax: 702-446-9253
Mailing address:
  • Phone: 702-540-5609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: