Healthcare Provider Details

I. General information

NPI: 1851923114
Provider Name (Legal Business Name): VICKY CARRENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 S DURANGO DR STE 102
LAS VEGAS NV
89113-1834
US

IV. Provider business mailing address

5575 S DURANGO DR STE 102
LAS VEGAS NV
89113-1834
US

V. Phone/Fax

Practice location:
  • Phone: 702-209-3544
  • Fax:
Mailing address:
  • Phone: 702-209-3544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: