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General NPI Number Information
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NPI Number | 1700489259
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Entity Type | Individual
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Provider Name | MARK INOUYE RBT
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Gender | Male
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 6200 W OAKEY BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89146-1103
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Country | US
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Telephone | 702-880-4083
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 PAVEENE AVE
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City | HENDERSON
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State | NV
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Zip | 89052-6592
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Country | US
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Telephone | 702-308-1042
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT1364
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License Number State | NV
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