Healthcare Provider Details

I. General information

NPI: 1376430959
Provider Name (Legal Business Name): LAJIYAH EMMA MIJAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 S RAINBOW BLVD
LAS VEGAS NV
89146-6237
US

IV. Provider business mailing address

3140 S RAINBOW BLVD
LAS VEGAS NV
89146-6237
US

V. Phone/Fax

Practice location:
  • Phone: 702-706-7635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number5423
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: