Healthcare Provider Details

I. General information

NPI: 1194035048
Provider Name (Legal Business Name): MR. MICHAEL RYAN LITTLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7260 W AZURE DR STE 140-44
LAS VEGAS NV
89130-7999
US

IV. Provider business mailing address

7260 W AZURE DR STE 140-44
LAS VEGAS NV
89130-7999
US

V. Phone/Fax

Practice location:
  • Phone: 702-789-7282
  • Fax:
Mailing address:
  • Phone: 702-789-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT2939
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: