MEDICARE: CLAUDIA AGUSTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1013785690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAUDIA AGUSTIN

Provider Business Mailing Address
First Line	:	1775 VILLAGE CENTER CIR STE 190
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0571
Country	:	US
Telephone Number	:	718-215-5311
Fax Number	:	718-865-5165

Provider Business Practice Location Address
First Line	:	1775 VILLAGE CENTER CIR STE 190
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0571
Country	:	US
Telephone Number	:	718-215-5311
Fax Number	:	718-865-5165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2023
Last Update Date	:	12/13/2023

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Directions to “ CLAUDIA AGUSTIN ” Practice Location

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