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General NPI Number Information
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NPI Number | 1043923519
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Entity Type | Individual
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Provider Name | RYAN STEVEN PEREZ-CARRILLO CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 12/29/2022
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 7121 W CRAIG RD STE 113-1207
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City | LAS VEGAS
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State | NV
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Zip | 89129-6001
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Country | US
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Telephone | 702-527-3142
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Fax | 702-549-7717
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Provider Business Mailing Address
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Address Line | 7450 W CHEYENNE AVE SUITE 103 PMB 1261
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City | LAS VEGAS
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State | NV
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Zip | 89129-1592
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Country | US
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Telephone | 702-527-3142
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 36625
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP-3551
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License Number State | NV
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