MEDICARE: HOLLY CARABAJAL

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	172V00000X	Community Health Worker
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1043564958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY CARABAJAL

Provider Business Mailing Address
First Line	:	6628 SKY POINTE DR STE 114
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4071
Country	:	US
Telephone Number	:	702-704-5112
Fax Number	:

Provider Business Practice Location Address
First Line	:	6628 SKY POINTE DR STE 114
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4071
Country	:	US
Telephone Number	:	702-704-5112
Fax Number	:

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

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	04/11/2018

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Directions to “ HOLLY CARABAJAL ” Practice Location

Language	Start Address	Practice Location

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