Healthcare Provider Details

I. General information

NPI: 1972982403
Provider Name (Legal Business Name): LINDA TERRAZAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 W SAHARA AVE APT 1006
LAS VEGAS NV
89117-5374
US

IV. Provider business mailing address

9550 W SAHARA AVE APT 1006
LAS VEGAS NV
89117-5374
US

V. Phone/Fax

Practice location:
  • Phone: 480-302-1780
  • Fax:
Mailing address:
  • Phone: 480-302-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225CA2500X
TaxonomyAssistive Technology Supplier Rehabilitation Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225CX0006X
TaxonomyOrientation and Mobility Training Rehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: