Healthcare Provider Details

I. General information

NPI: 1487990701
Provider Name (Legal Business Name): MR. CRAIG ANTHONY HUTTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 CINDY LOVE AVE.
NORTH LAS VEGAS NV
89081
US

IV. Provider business mailing address

1208 CINDY LOVE AVE.
NORTH LAS VEGAS NV
89081
US

V. Phone/Fax

Practice location:
  • Phone: 702-712-5675
  • Fax:
Mailing address:
  • Phone: 702-712-5675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: