Individual
ETHAN ROOSEVELT MOMPREMIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11500 S EASTERN AVE STE 150, HENDERSON, NV 89052-5576
(760) 856-0607
Mailing address
8993 ECHO GRANDE DR, LAS VEGAS, NV 89131-6714
(702) 683-5304
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/20/2026
Last updated
04/20/2026
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