MEDICARE: ERICA ZALDIVAR

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1134421225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA ZALDIVAR

Provider Business Mailing Address
First Line	:	2831 SAINT ROSE PKWY STE 236
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4840
Country	:	US
Telephone Number	:	702-589-4865
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 SAINT ROSE PKWY STE 236
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4840
Country	:	US
Telephone Number	:	702-589-4865
Fax Number	:

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

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	11/23/2010

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