Healthcare Provider Details

I. General information

NPI: 1336583327
Provider Name (Legal Business Name): RICHELLE URENDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 N RANCHO DR
LAS VEGAS NV
89130-3180
US

IV. Provider business mailing address

211 MISSION LAGUNA LN # 169
LAS VEGAS NV
89107-2719
US

V. Phone/Fax

Practice location:
  • Phone: 702-869-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: