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NPI Code Detail

MEDICARE: BRIANNA LYNN DEPALO

MEDICARE:   BRIANNA LYNN DEPALO
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
1103K00000XBehavior Analyst617659NV

General Provider Information

NPI Number : 1124751573
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIANNA LYNN DEPALO
Provider Business Mailing Address
First Line : 10655 COLLEGE HILL AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89166-6562
Country : US
Telephone Number : 631-782-4376
Fax Number :
Provider Business Practice Location Address
First Line : 2340 W HORIZON RIDGE PKWY
Second Line :
City : HENDERSON
State : NV
Zip : 89052-5074
Country : US
Telephone Number : 702-610-2076
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2022
Last Update Date : 07/04/2022

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Directions to “ BRIANNA LYNN DEPALO ” Practice Location

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