MEDICARE: DONNA RIVERA DESEMBRANA

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

General Provider Information

NPI Number	:	1982259438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA RIVERA DESEMBRANA

Provider Business Mailing Address
First Line	:	4000 S EASTERN AVE STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0840
Country	:	US
Telephone Number	:	702-476-0262
Fax Number	:

Provider Business Practice Location Address
First Line	:	9255 ONESTO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2686
Country	:	US
Telephone Number	:	702-332-7561
Fax Number	:

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

Provider Enumeration Date	:	08/01/2019
Last Update Date	:	08/01/2019

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Directions to “ DONNA RIVERA DESEMBRANA ” Practice Location

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