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NPI Code Detail

MEDICARE: SOPHINAVIDA NICCI ROS

MEDICARE: SOPHINAVIDA NICCI ROS
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 : 1255106530
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHINAVIDA NICCI ROS
Provider Business Mailing Address
First Line : 74 N PECOS RD STE C
Second Line :
City : HENDERSON
State : NV
Zip : 89074-7344
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 74 N PECOS RD STE C
Second Line :
City : HENDERSON
State : NV
Zip : 89074-7344
Country : US
Telephone Number : 657-444-9002
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2023
Last Update Date : 03/16/2026

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Directions to “ SOPHINAVIDA NICCI ROS ” Practice Location

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