Healthcare Provider Details

I. General information

NPI: 1538728936
Provider Name (Legal Business Name): JEFFREY KOICHI CANZANI BCBA, RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 VILLAGE CENTER CIR STE 140
LAS VEGAS NV
89134-0577
US

IV. Provider business mailing address

1707 VILLAGE CENTER CIR STE 140
LAS VEGAS NV
89134-0577
US

V. Phone/Fax

Practice location:
  • Phone: 702-766-9840
  • Fax:
Mailing address:
  • Phone: 702-766-9840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT0845
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-85902
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: