Individual
KAILI MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
731 MALL RING CIR STE 215, HENDERSON, NV 89014-6691
(702) 547-9671
Mailing address
731 MALL RING CIR STE 215, HENDERSON, NV 89014-6691
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-82000
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106S00000X
—
NV
Enumeration date
03/26/2019
Last updated
03/26/2019
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