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NPI Code Detail

MEDICARE: EDGAR KEVIN PEREZ

MEDICARE:   EDGAR KEVIN PEREZ
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 Analyst

General Provider Information

NPI Number : 1487085635
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDGAR KEVIN PEREZ
Provider Business Mailing Address
First Line : 1111 S CASINO CENTER BLVD APT 3
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-1048
Country : US
Telephone Number : 702-351-6958
Fax Number :
Provider Business Practice Location Address
First Line : 3225 MCLEOD DR
Second Line : PARADISE BEHAVIROAL
City : LAS VEGAS
State : NV
Zip : 89121-2257
Country : US
Telephone Number : 702-326-7428
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2013
Last Update Date : 12/12/2013

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Directions to “ EDGAR KEVIN PEREZ ” Practice Location

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