Healthcare Provider Details

I. General information

NPI: 1962962993
Provider Name (Legal Business Name): JOCELYN RUVALCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 W CHARLESTON BLVD STE 22
LAS VEGAS NV
89102-1933
US

IV. Provider business mailing address

6130 W TROPICANA AVE # 145
LAS VEGAS NV
89103-4604
US

V. Phone/Fax

Practice location:
  • Phone: 702-900-7698
  • Fax: 702-825-0791
Mailing address:
  • Phone: 702-900-7698
  • Fax: 702-825-0791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-91351
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: