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NPI Code Detail

MEDICARE: ROSA ANGELICA SANDOVAL

MEDICARE: ROSA ANGELICA SANDOVAL
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
1106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RBT-18-49636OTHERNVREGISTERED BEHAVIOR TECHNICIAN

General Provider Information

NPI Number : 1518468073
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSA ANGELICA SANDOVAL
Provider Business Mailing Address
First Line : 1632 LENWOOD AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-5200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4325 N RANCHO DR STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-3439
Country : US
Telephone Number : 702-510-6393
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2018
Last Update Date : 02/21/2018

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Directions to “ ROSA ANGELICA SANDOVAL ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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