Healthcare Provider Details

I. General information

NPI: 1538770128
Provider Name (Legal Business Name): YANIRA MARQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7261 W CHARLESTON BLVD STE 101
LAS VEGAS NV
89117-1679
US

IV. Provider business mailing address

7261 W CHARLESTON BLVD STE 101
LAS VEGAS NV
89117-1679
US

V. Phone/Fax

Practice location:
  • Phone: 702-396-0101
  • Fax: 702-222-0212
Mailing address:
  • Phone: 702-396-0101
  • Fax: 702-222-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-121424
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: