MEDICARE: CARLA GABRIELA MOWEN BA

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

General Provider Information

NPI Number	:	1336415389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA GABRIELA MOWEN BA

Provider Business Mailing Address
First Line	:	7416 SPEEDWELL CAVERN ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-5358
Country	:	US
Telephone Number	:	808-445-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	3037 E WARM SPRINGS RD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3759
Country	:	US
Telephone Number	:	702-780-8447
Fax Number	:

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

Provider Enumeration Date	:	03/23/2012
Last Update Date	:	09/17/2024

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