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General NPI Number Information
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NPI Number | 1245710946
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Entity Type | Individual
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Provider Name | MATTHEW NIKOA LIM
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Gender | Male
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 3620 N RANCHO DR STE 117
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City | LAS VEGAS
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State | NV
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Zip | 89130-3154
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Country | US
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Telephone | 702-655-6560
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 E HACIENDA AVE
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City | LAS VEGAS
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State | NV
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Zip | 89119-2819
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Country | US
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Telephone | 702-487-2905
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | NV
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