Individual
ANDRE EAGLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6330 W AZURE DR, LAS VEGAS, NV 89130-7287
(702) 800-1932
Mailing address
6330 W AZURE DR, LAS VEGAS, NV 89130-7287
(170) 250-2330
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1501017565
DRIVER LICENSE
NV
Enumeration date
10/24/2018
Last updated
10/24/2018
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