MEDICARE: ALEXIS MONIQUE MOLINA

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	RBT-20-148330	NV

General Provider Information

NPI Number	:	1811584949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS MONIQUE MOLINA

Provider Business Mailing Address
First Line	:	7092 SPRING BEAUTY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-0136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5575 S DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1833
Country	:	US
Telephone Number	:	702-209-3544
Fax Number	:

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

Provider Enumeration Date	:	12/22/2020
Last Update Date	:	12/22/2020

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Directions to “ ALEXIS MONIQUE MOLINA ” Practice Location

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