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General NPI Number Information
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NPI Number | 1992573265
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Entity Type | Individual
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Provider Name | KAZEEM SHINABA II
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Gender | Male
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 7251 W LAKE MEAD BLVD STE 300
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City | LAS VEGAS
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State | NV
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Zip | 89128-8380
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Country | US
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Telephone | 502-387-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 3854 TATIANA ST
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City | LAS VEGAS
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State | NV
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Zip | 89115-2405
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Country | US
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Telephone | 725-502-7530
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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-23-269917
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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