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NPI Code Detail

MEDICARE: SPECTRUM NEVADA HEALTHCARE SERVICES LLC

MEDICARE: SPECTRUM NEVADA HEALTHCARE SERVICES LLC
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1215662838
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPECTRUM NEVADA HEALTHCARE SERVICES LLC
Provider Business Mailing Address
First Line : 1767 QUIVER POINT AVE
Second Line :
City : HENDERSON
State : NV
Zip : 89012-3482
Country : US
Telephone Number : 725-254-8037
Fax Number :
Provider Business Practice Location Address
First Line : 1767 QUIVER POINT AVE
Second Line :
City : HENDERSON
State : NV
Zip : 89012-3482
Country : US
Telephone Number : 725-254-8037
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CARLOS ALBERTO BAEZA RIVERO
Credential :
Telephone Number : 725-254-8037
Provider Enumeration Date : 07/18/2022
Last Update Date : 09/22/2023

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