Healthcare Provider Details

I. General information

NPI: 1851829543
Provider Name (Legal Business Name): SAMANTHA RENEE VITONE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 05/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RANCHO DR STE A
LAS VEGAS NV
89106-4849
US

IV. Provider business mailing address

634 W AZURE AVE
N LAS VEGAS NV
89031-1736
US

V. Phone/Fax

Practice location:
  • Phone: 702-998-9505
  • Fax:
Mailing address:
  • Phone: 702-808-1703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-17-32610
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: