MEDICARE: CHRISTIAN IPALARI RAFANAN AA

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	103K00000X	Behavior Analyst	BACB1306531	NV

General Provider Information

NPI Number	:	1821986522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN IPALARI RAFANAN AA

Provider Business Mailing Address
First Line	:	4000 S EASTERN AVE STE 240
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0847
Country	:	US
Telephone Number	:	702-848-1696
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 S EASTERN AVE STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0809
Country	:	US
Telephone Number	:	702-848-1696
Fax Number	:

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

Provider Enumeration Date	:	06/24/2025
Last Update Date	:	06/24/2025

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