Healthcare Provider Details

I. General information

NPI: 1619772936
Provider Name (Legal Business Name): ERICK X PHILL RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 W SAHARA AVE STE 115
LAS VEGAS NV
89117-2753
US

IV. Provider business mailing address

7730 W SAHARA AVE STE 115
LAS VEGAS NV
89117-2753
US

V. Phone/Fax

Practice location:
  • Phone: 702-660-2005
  • Fax: 702-620-4808
Mailing address:
  • Phone: 702-660-2005
  • Fax: 702-620-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT4160
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: