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NPI Code Detail

MEDICARE: SHIRLEY COBB

MEDICARE:   SHIRLEY  COBB
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 : 1497177885
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHIRLEY COBB
Provider Business Mailing Address
First Line : 4249 N COMMERCE ST UNIT 1117
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-1196
Country : US
Telephone Number : 702-750-8473
Fax Number :
Provider Business Practice Location Address
First Line : 4249 N COMMERCE ST UNIT 1117
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-1196
Country : US
Telephone Number : 702-750-8473
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2014
Last Update Date : 01/20/2014

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Directions to “ SHIRLEY COBB ” Practice Location

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