Healthcare Provider Details

I. General information

NPI: 1518740125
Provider Name (Legal Business Name): CHRISTOPHER KUNICKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 N DECATUR BLVD STE D
LAS VEGAS NV
89108-2957
US

IV. Provider business mailing address

2481 N DECATUR BLVD STE D
LAS VEGAS NV
89108-2957
US

V. Phone/Fax

Practice location:
  • Phone: 702-561-3708
  • Fax: 702-527-6337
Mailing address:
  • Phone: 702-561-3708
  • Fax: 702-527-6337

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: