Individual
IVAN PATRICK ELIAS MORELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
5859 W TALAVI BLVD STE 180, GLENDALE, AZ 85306-1873
(602) 560-2836
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-95256
AZ
Other
Enumeration date
08/19/2020
Last updated
08/19/2020
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