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NPI Code Detail

MEDICARE: KERRI PAVALON

MEDICARE: KERRI PAVALON
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 Analyst

General Provider Information

NPI Number : 1194016501
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRI PAVALON
Provider Business Mailing Address
First Line : 777 N RAINBOW BLVD STE 385
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-1188
Country : US
Telephone Number : 702-473-9590
Fax Number :
Provider Business Practice Location Address
First Line : 777 N RAINBOW BLVD STE 385
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-1188
Country : US
Telephone Number : 702-473-9590
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2011
Last Update Date : 04/20/2011

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Directions to “ KERRI PAVALON ” Practice Location

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