MEDICARE: JORGE ANTONIO MENDEZ TOCABENS

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

General Provider Information

NPI Number	:	1972156909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE ANTONIO MENDEZ TOCABENS

Provider Business Mailing Address
First Line	:	6501 VEGAS DR APT 1055
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-7735
Country	:	US
Telephone Number	:	702-624-2915
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 E FLAMINGO RD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0831
Country	:	US
Telephone Number	:	702-620-5105
Fax Number	:

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

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	07/18/2019

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