MEDICARE: SORAYA ZAHRA ROBERTSON

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

General Provider Information

NPI Number	:	1508355611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SORAYA ZAHRA ROBERTSON

Provider Business Mailing Address
First Line	:	2626 S RAINBOW BLVD STE 203
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5190
Country	:	US
Telephone Number	:	702-818-3666
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 S RAINBOW BLVD STE 203
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5190
Country	:	US
Telephone Number	:	702-818-3666
Fax Number	:

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

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	05/03/2018

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