MEDICARE: DR. ALAN R FLITTON PSYD

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	103T00000X	Psychologist	PSY17948	CA
2	103TF0200X	Forensic Psychologist	PSY17948	CA
3	103TC0700X	Clinical Psychologist	PY0633	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PY0633	OTHER	NV	NEVADA BOARD OF PSYCHOLOGICAL EXAMINERS
2	PSY179480	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1356488217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN R FLITTON PSYD

Provider Business Mailing Address
First Line	:	5940 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2540
Country	:	US
Telephone Number	:	619-867-2992
Fax Number	:

Provider Business Practice Location Address
First Line	:	5940 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2540
Country	:	US
Telephone Number	:	619-867-2992
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	03/15/2016

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