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NPI Code Detail

MEDICARE: GWENDOLYN NAOMI ROBLEDO B.A.

MEDICARE: GWENDOLYN NAOMI ROBLEDO B.A.
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
2103K00000XBehavior AnalystLBA0853NV

General Provider Information

NPI Number : 1700444908
Entity Type Code : Individual
Provider Name (Legal Business Name) : GWENDOLYN NAOMI ROBLEDO B.A.
Provider Business Mailing Address
First Line : 241 JADED IRIS CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-3978
Country : US
Telephone Number : 702-592-9518
Fax Number :
Provider Business Practice Location Address
First Line : 7730 W SAHARA AVE STE 115
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-2753
Country : US
Telephone Number : 702-660-2005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2019
Last Update Date : 01/31/2024

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