MEDICARE: KATI ROSELYN RUIZ-CASTILLO

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	RBT4084	NV

General Provider Information

NPI Number	:	1619734340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATI ROSELYN RUIZ-CASTILLO

Provider Business Mailing Address
First Line	:	7245 BRIDGEVIEW AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-4511
Country	:	US
Telephone Number	:	702-337-9396
Fax Number	:

Provider Business Practice Location Address
First Line	:	8020 PINYON RIDGE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-6580
Country	:	US
Telephone Number	:	702-904-9646
Fax Number	:

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

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	02/29/2024

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Directions to “ KATI ROSELYN RUIZ-CASTILLO ” Practice Location

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