Healthcare Provider Details

I. General information

NPI: 1912255779
Provider Name (Legal Business Name): ANDRE RASHAWN YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5615 S PECOS RD
LAS VEGAS NV
89120-1961
US

IV. Provider business mailing address

2365 RAWHIDE ST
LAS VEGAS NV
89119-2836
US

V. Phone/Fax

Practice location:
  • Phone: 702-736-8100
  • 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: