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NPI Code Detail

MEDICARE: MR. EUGENE DWAYNE LIVINGSTON JR.

MEDICARE: MR. EUGENE DWAYNE LIVINGSTON JR.
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 TechnicianRBTNV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RBTOTHERNVREGISTERED BEHAVIOR TECHNICIAN

General Provider Information

NPI Number : 1528582418
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EUGENE DWAYNE LIVINGSTON JR.
Provider Business Mailing Address
First Line : 3108 COUNTRY DANCER AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081
Country : US
Telephone Number : 310-904-9711
Fax Number :
Provider Business Practice Location Address
First Line : 731 MALL RING CIR STE 215
Second Line :
City : HENDERSON
State : NV
Zip : 89014-6691
Country : US
Telephone Number : 702-547-6971
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2017
Last Update Date : 08/01/2017

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