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NPI Code Detail

MEDICARE: JERRY LAMASCUS

MEDICARE: JERRY LAMASCUS
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 AnalystNV

General Provider Information

NPI Number : 1356620488
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY LAMASCUS
Provider Business Mailing Address
First Line : 2441 TECH CENTER CT
Second Line : STE 108
City : LAS VEGAS
State : NV
Zip : 89128-0804
Country : US
Telephone Number : 702-629-6351
Fax Number : 702-629-6367
Provider Business Practice Location Address
First Line : 7320 SMOKE RANCH RD STE H
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0259
Country : US
Telephone Number : 702-380-0600
Fax Number : 702-658-1039
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2011
Last Update Date : 02/13/2018

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