MEDICARE: MRS. WEVIELYN ENVERGA MANINGAS RBT

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	00005321	CA
2	106S00000X	Behavior Technician	RBT-19-87949	NV

General Provider Information

NPI Number	:	1942794177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WEVIELYN ENVERGA MANINGAS RBT

Provider Business Mailing Address
First Line	:	7616 FINISHING TOUCH CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0458
Country	:	US
Telephone Number	:	650-290-0721
Fax Number	:

Provider Business Practice Location Address
First Line	:	7125 GRAND MONTECITO PKWY STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0261
Country	:	US
Telephone Number	:	702-396-0101
Fax Number	:

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

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	06/12/2020

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