Healthcare Provider Details

I. General information

NPI: 1841656071
Provider Name (Legal Business Name): DIANA OBREGON-ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 05/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 ARROYO CROSSING PKWY STE 220
LAS VEGAS NV
89113
US

IV. Provider business mailing address

7455 ARROYO CROSSING PKWY STE 220
LAS VEGAS NV
89113-4088
US

V. Phone/Fax

Practice location:
  • Phone: 321-443-9191
  • Fax: 702-483-6410
Mailing address:
  • Phone: 321-443-9191
  • Fax: 702-483-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-17319
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: