MEDICARE: ACADEMIC ASSOCIATES INTEC INC

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	103T00000X	Psychologist	LEP2606	CA

General Provider Information

NPI Number	:	1053466573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADEMIC ASSOCIATES INTEC INC

Provider Business Mailing Address
First Line	:	848 N RAINBOW BLVD # 2185
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1103
Country	:	US
Telephone Number	:	714-692-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	848 N RAINBOW BLVD # 2185
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1103
Country	:	US
Telephone Number	:	714-692-5555
Fax Number	:

Authorized Official
Title or Position	:	PRESIDNET
Name	:	DR. ROGER WELLS
Credential	:
Telephone Number	:	714-692-5555

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2020

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