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General NPI Number Information
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NPI Number | 1811680507
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Entity Type | Individual
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Provider Name | AUDREY ELLENE CORPUZ VIOS
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Gender | Female
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 06/13/2025
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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
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Country | US
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Telephone | 702-623-3363
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Fax |
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Provider Business Mailing Address
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Address Line | 304 S JONES BLVD UNIT 7733
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City | LAS VEGAS
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State | NV
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Zip | 89107-2623
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Country | US
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Telephone |
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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 | RBT-23-268092
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License Number State | NV
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