MEDICARE: IVETTE STEPHANIE GARCIA RETIRADO

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
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1134627276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVETTE STEPHANIE GARCIA RETIRADO

Provider Business Mailing Address
First Line	:	1591 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2502
Country	:	US
Telephone Number	:	702-525-6889
Fax Number	:

Provider Business Practice Location Address
First Line	:	1591 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169
Country	:	US
Telephone Number	:	702-202-0291
Fax Number	:

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

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	06/08/2019

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