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NPI Code Detail

MEDICARE: MR. TIMOTHY DIZON BATHAN QMHA

MEDICARE: MR. TIMOTHY DIZON BATHAN QMHA
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 : 1215247721
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY DIZON BATHAN QMHA
Provider Business Mailing Address
First Line : 1810 E SAHARA AVE STE 200
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-3735
Country : US
Telephone Number : 702-207-6782
Fax Number :
Provider Business Practice Location Address
First Line : 1810 E SAHARA AVE STE 200
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-3735
Country : US
Telephone Number : 702-207-6782
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2010
Last Update Date : 04/01/2011

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