Individual
ELIZA EVERLASTING VO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2715 E RUSSELL RD, LAS VEGAS, NV 89120-2426
(725) 238-4115
Mailing address
3001 LAKE EAST DR APT 2159, LAS VEGAS, NV 89117-2225
(515) 414-5585
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
IA
Other
Enumeration date
09/02/2024
Last updated
09/02/2024
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