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NPI Code Detail

MEDICARE: LIZBETH AVALOS-GONZALEZ

MEDICARE: LIZBETH AVALOS-GONZALEZ
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

General Provider Information

NPI Number : 1750014098
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIZBETH AVALOS-GONZALEZ
Provider Business Mailing Address
First Line : 7995 BLUE DIAMOND RD STE 102-304
Second Line :
City : LAS VEGAS
State : NV
Zip : 89178-9301
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7995 BLUE DIAMOND RD STE 102-304
Second Line :
City : LAS VEGAS
State : NV
Zip : 89178-9301
Country : US
Telephone Number : 702-848-6070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2022
Last Update Date : 07/05/2022

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Directions to “ LIZBETH AVALOS-GONZALEZ ” Practice Location

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