Healthcare Provider Details

I. General information

NPI: 1811446818
Provider Name (Legal Business Name): BERENICE SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2016
Last Update Date: 10/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7261 W CHARLESTON BLVD SUITE 101
LAS VEGAS NV
89117-1636
US

IV. Provider business mailing address

7261 W CHARLESTON BLVD SUITE 101
LAS VEGAS NV
89117-1636
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-15-04832
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: