MEDICARE: MS. GISELLE N/A RODRIGUEZ MONTENEGRO RBT

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	106S00000X	Behavior Technician	RBT-24-381728	NV

General Provider Information

NPI Number	:	1457245920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GISELLE N/A RODRIGUEZ MONTENEGRO RBT

Provider Business Mailing Address
First Line	:	8250 N GRAND CANYON DR
Second Line	:	2060
City	:	LAS VEGAS
State	:	NV
Zip	:	89166
Country	:	US
Telephone Number	:	725-303-8745
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 S RAINBOW BLVD STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6227
Country	:	US
Telephone Number	:	702-600-0099
Fax Number	:

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

Provider Enumeration Date	:	06/07/2025
Last Update Date	:	06/07/2025

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