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General NPI Number Information
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NPI Number | 1154970515
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Entity Type | Organization
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Legal Business Name | FUNXIONAL BEHAVIOR ANALYSIS
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 8433 SABLE BEAUTY ST
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City | LAS VEGAS
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State | NV
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Zip | 89131-2055
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Country | US
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Telephone | 702-964-8996
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Fax |
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Provider Business Mailing Address
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Address Line | 8433 SABLE BEAUTY ST
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City | LAS VEGAS
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State | NV
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Zip | 89131-2055
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Country | US
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Telephone | 702-964-8996
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | DR. KRISTINE JOY CORTEZ
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Credential |
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Telephone | 310-987-5009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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