Individual
ALFONSO MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8275 S EASTERN AVE, LAS VEGAS, NV 89123-2591
(702) 919-1032
Mailing address
8275 S EASTERN AVE, LAS VEGAS, NV 89123-2591
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
823385692
—
NV
Enumeration date
11/13/2017
Last updated
11/13/2017
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