MEDICARE: RYAN STEVEN PEREZ-CARRILLO CCC-SLP

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	235Z00000X	Speech-Language Pathologist	36625	CA
2	235Z00000X	Speech-Language Pathologist	SP-3551	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043923519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN STEVEN PEREZ-CARRILLO CCC-SLP

Provider Business Mailing Address
First Line	:	7450 W CHEYENNE AVE
Second Line	:	SUITE 103 PMB 1261
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-1592
Country	:	US
Telephone Number	:	702-527-3142
Fax Number	:

Provider Business Practice Location Address
First Line	:	7121 W CRAIG RD STE 113-1207
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6001
Country	:	US
Telephone Number	:	702-527-3142
Fax Number	:	702-549-7717

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

Provider Enumeration Date	:	12/29/2022
Last Update Date	:	04/30/2024

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Directions to “ RYAN STEVEN PEREZ-CARRILLO CCC-SLP” Practice Location

Language	Start Address	Practice Location

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